Quantifying dimensions of physical behavior in chronic pain conditions.

BACKGROUND: Chronic pain, defined as persistent or recurrent pain lasting longer than 3 months, is a frequent condition affecting an important percent of population worldwide. Pain chronicity can be caused by many different factors and is a frequent component of many neurological disorders. An important aspect for clinical assessment and design of effective treatment and/or rehabilitation strategies is to better understand the impact of pain on domains of functioning in everyday life. The aim of this study was to identify the objectively quantifiable features of physical functioning in daily life and to evaluate their effectiveness to differentiate behavior among subjects with different pain conditions. METHOD: Body worn sensors were used to record movement data during five consecutive days in 92 subjects. Sensor data were processed to characterize the physical behavior in terms of type, intensity, duration and temporal pattern of activities, postures and movements performed by subjects in daily life. Metrics quantifying these features were subsequently used to devise composite scores using a factor analysis approach. The severity of clinical condition was assessed using a rating of usual pain intensity on a 10-cm visual analog scale. The relationship between pain intensity and the estimated metrics/composite scores was assessed using multiple regression and discriminant analysis. RESULTS: According to the factor analysis solution, two composite scores were identified, one integrating the metrics quantifying the amount and duration of activity periods, and the other the metrics quantifying complexity of temporal patterns, i.e., the diversity of body movements and activities, and the manner in which they are organized throughout time. All estimated metrics and composite scores were significantly different between groups of subjects with clinically different pain levels. Moreover, analysis revealed that pain intensity seemed to have a more significant impact on the overall physical behavior, as it was quantified by a global composite score, whereas the type of chronic pain appeared to influence mostly the complexity of the temporal pattern. CONCLUSION: The methodology described could be informative for the design of objective outcome measures in chronic pain management/rehabilitation programs

A 340 kDa hyaluronic acid secreted by human vascular smooth muscle cells regulates their proliferation and migration

The formation of atherosclerotic lesions is characterized by invasion of vascular smooth muscle cells (VSMC) into the tunica intima of the arterial wall and subsequently by increased proliferation of VSMC, a process apparently restricted to the intimal layer of blood vessels. Both events are preceded by the pathological overexpression of several growth factors, such as platelet-derived growth factor (PDGF) which is a potent mitogen for VSMC and can induce their chemotaxis. PDGF is generally not expressed in the normal artery but it is upregulated in atherosclerotic lesions. We have previously shown that PDGF-BB specifically stimulates proliferating VSMC to secrete a 340 kDa hyaluronic acid (HA-340). Here, we present evidence regarding the biological functions of this glycan. We observed that HA-340 inhibited the PDGF-induced proliferation of human VSMC in a dosedependent manner and enhanced the PDGF-dependent invasion of VSMC through a basement membrane barrier. These effects were abolished following treatment of HA-340 with hyaluronidase. The effect of HA-340 on the PDGF-dependent invasion of VSMC coincided with increased secretion of the 72-kDa type IV collagenase by VSMC and was completely blocked by GM6001, a hydroxamic acid inhibitor of matrix metalloproteinases. HA-340 did not exert any chemotactic potency, nor did it affect chemotaxis of VSMC along a PDGF gradient. In human atheromatic aortas, we found that HA-340 is expressed with a negative concentration gradient from the tunica media to the tunica intima and the atheromatic plaque. Our findings suggest that HA-340 may be linked to the pathogenesis of atherosclerosis, by modulating VSMC proliferation and invasio

Biomimetic rehabilitation engineering: the importance of somatosensory feedback for brain-machine interfaces.

Brain-machine interfaces (BMIs) re-establish communication channels between the nervous system and an external device. The use of BMI technology has generated significant developments in rehabilitative medicine, promising new ways to restore lost sensory-motor functions. However and despite high-caliber basic research, only a few prototypes have successfully left the laboratory and are currently home-deployed. The failure of this laboratory-to-user transfer likely relates to the absence of BMI solutions for providing naturalistic feedback about the consequences of the BMI's actions. To overcome this limitation, nowadays cutting-edge BMI advances are guided by the principle of biomimicry; i.e. the artificial reproduction of normal neural mechanisms. Here, we focus on the importance of somatosensory feedback in BMIs devoted to reproducing movements with the goal of serving as a reference framework for future research on innovative rehabilitation procedures. First, we address the correspondence between users' needs and BMI solutions. Then, we describe the main features of invasive and non-invasive BMIs, including their degree of biomimicry and respective advantages and drawbacks. Furthermore, we explore the prevalent approaches for providing quasi-natural sensory feedback in BMI settings. Finally, we cover special situations that can promote biomimicry and we present the future directions in basic research and clinical applications. The continued incorporation of biomimetic features into the design of BMIs will surely serve to further ameliorate the realism of BMIs, as well as tremendously improve their actuation, acceptance, and use

Vegetation and Topographic Control on Spatial Variability of Soil Organic Carbon

Soil organic carbon (SOC) is one of the most important parameters affecting the hydraulic characteristics of natural soils. Despite being rather easy to measure, SOC is known to be highly variable in space. In this study, vegetation, climate, and morphology factors were used to reproduce the spatial distribution of SOC in the mineral horizons of forest and grassland areas in north-western Italy and the feasibility of the approach was evaluated. When the overall sample (114 samples) was analyzed, average annual rainfall and elevation were significant descriptors of the SOC variability. However, a large part of the variability remains unexplained. Two stratification criteria were then adopted, based on vegetation and topographic properties. We obtained an improvement of the quality of the estimates, particularly for grasslands and forests in the absence of local curvatures. These results indicate that the spatial variability of soil organic matter is scarcely reproducible at the regional scale, unless an a-priori reduction of the heterogeneity is applied. A discussion on the feasibility of applying stratification criteria to deal with heterogeneous samples closes the pape

Models of Integrated Acute Care for Older Adult Inpatients That Incorporate Integrative Health: An Integrative Review

Eric Bonvin,1 Elodie Perruchoud,2 Nadine Tacchini-Jacquier,1 Jean Perrenoud,1 Pauline Melly,2 Sacha Celik,3 Michèle Jean,4 Henk Verloo2 1Valais Hospital Directorate 1950 SION, Valais, Switzerland; 2School of Health Sciences – Nursing Science (HES-SO – Valais) 1950 SION, Valais, Switzerland; 3Old Age Psychiatry - Saint-Amé Clinic 1890 Saint-Maurice, Valais, Switzerland; 4Geriatrics - Saint-Amé Clinic 1890 Saint-Maurice, Valais, SwitzerlandCorrespondence: Henk Verloo, Email [email protected]: The use of integrated acute care for older adult inpatients is a growing field, especially the use of integrative health-care practices for managing complex, chronic, age-related health conditions. Scientific evidence suggests that these practices should be incorporated into older adult inpatients’ daily care.Aim: Conduct an integrative review of studies on integrated acute-care models for older adult inpatients that incorporate integrative health services.Methods: We searched Medline Ovid ALL, Embase.com, CINAHL, APA PsycINFO Ovid, Web of Science Core Collection, ProQuest Dissertations & Theses A&I, Cochrane Library, and CAMBase bibliographic databases for studies, published between 1990 and 2023, on integrated acute-care models for older adult inpatients that incorporated integrative health services. The search associated the domains of acute care, geriatrics, internal medicine, rehabilitation, hospitalization, geriatric psychiatry, integrated/integrative care, care models, practices and coordination, interprofessionalism and multidisciplinarity, collaborative practices, and complementary therapies. The review was completed in June 2024.Results: We retained 32 studies conducted in North America, Europe, Australia, and Asia, including 46,899 older adult inpatients, 39 physicians, 148 nurses, 695 allied health-care professionals, and 358 informal caregivers. Three integrated acute care models were identified: the Acute Care for Elders model, the Integrated General Hospital model, and the Transitional Care model. Three integrated acute psychogeriatric-care models were identified: the Admiral Nursing model, the Lewy body dementia Admiral nursing service model, and the Care for Acute Mentally Infirm Elders model. A single, hybrid, Integrated, People-Centred Health Services model for acute and community health care was identified. We found the Scaling Integrated Care in Context model for measuring integrated care development within health-care systems.Conclusion: Few studies have investigated integrated acute-care models incorporating integrative health services for older adult inpatients. Existing acute-care models including integrative medicine should be explored further, and new, more inclusive models should be developed.Keywords: integrated care, integration, acute care, geriatrics, geriatric psychiatry, complementary medicine, integrative health, care model

Comparison of the Effects of Intermittent Boluses to Simple Continuous Infusion on Patients’ Global Perceived Effect in Intrathecal Therapy for Pain: A Randomized Double-Blind Crossover Study

Objective: Intrathecal drug delivery (ITDD) is commonly used for intractable pain management. A paucity of good quality studies in chronic non-cancer patients and concerns over increased dosages has focused interest on different modes of administration. The aim of this international multicentre randomised double-blind crossover trial was to compare the efficacy of the same daily dose of drugs administered by intermittent boluses versus simple continuous infusion. Methods: Eligible patients implanted with a programmable ITDD device were randomised to receive two weeks of either intermittent boluses or a simple continuous flow in period 1, followed by a crossover to the alternative mode of administration. The primary outcome measure was the Patients’ Global Impression of Change (PGIC) scale. Results: The mean proportion of positive responders (at least “minimally improved”) was 38.4% in the Continuous condition versus 37.3% in the Bolus (difference in proportions = 1.1%; 95% CI, -21.8 to 24.0%; P=0.93). The mean PGIC in the Continuous condition was 3.8 versus 3.9 in the Bolus (mean difference = -0.1; -0.6 to 0.4; P=0.72). Exploratory analyses revealed a tendency for the mean proportion of positive responders to be higher at low vs. high flow rates for both bolus and continuous administrations. Two patients were withdrawn from the study due to adverse events during the Bolus phase: both with symptoms of increased pain, and one patient with additional symptoms of numbness and urinary retention. Conclusion: The mean PGIC and proportion of positive responders was not substantially different after intermittent bolus versus continuous administration

Ethical procedures and patient consent differ in Europe

BACKGROUND: Research ethics approvals, procedures and requirements for institutional research ethics committees vary considerably by country and by type of organisation. OBJECTIVE: To evaluate the requirements and procedures of research ethics committees, details of patient information and informed consent based on a multicentre European trial. DESIGN: Survey of European hospitals participating in the prospective observational study on chronic postsurgical pain (euCPSP) using electronic questionnaires. SETTING: Twenty-four hospitals in 11 European countries. PARTICIPANTS: From the 24 hospitals, 23 local investigators responded; 23 answers were analysed. OUTCOME MEASURES: Comparison of research ethics procedures and committee requirements from the perspective of clinical researchers. Comparison of the institutions' procedures regarding patient information and consent. Description of further details such as costs and the duration of the approval process. RESULTS: The approval process lasted from less than 2 weeks up to more than 2 months with financial fees varying between 0 and 575 €. In 20 hospitals, a patient information sheet of variable length (half page up to two pages) was provided. Requirements for patients' informed consent differed. Written informed consent was mandatory at 12, oral at 10 and no form of consent at one hospital. Details such as enough time for consideration, possibility for withdrawal and risks/benefits of participation were provided in 25 to 30% of the institutions. CONCLUSION: There is a considerable variation in the administrative requirements for approval procedures by research ethics committees in Europe. This results in variation of the extent of information and consent procedures for the patients involved

Induction of interleukin 6 and interleukin 8 expression by Broncho-Vaxom (OM-85 BV) via C-Fos/serum responsive element.

BACKGROUND: Broncho-Vaxom (OM-85 BV) increases the resistance of the respiratory tract to bacterial infections by modulating host immune responses. The compound increases serum IgG levels but decreases IgE levels in patients suffering from chronic bronchitis or chronic obstructive pulmonary disease. It increases concentrations of gamma-interferon (IFN-gamma), IgA, and interleukin (IL)-2 in bronchoalveolar lavage fluid of patients with bronchitis. Treatment with OM-85 BV increases the number of T helper and natural killer cells. In this study the effects of OM-85 BV on transcription of cytokines is investigated in human lung fibroblasts. METHODS: Transcription and synthesis of IL-6 and IL-8 were assessed in cultured primary human lung fibroblasts using standard methods of Northern blot analysis for the level of mRNAs and enzyme linked immunosorbent assay for proteins. RESULTS: Broncho-Vaxom (OM-85 BV) at different concentrations induced transcription of IL-6 and IL-8. The effect of the drug on transcription of IL-6 and IL-8 genes correlated with secretion of the proteins into cell supernatants. OM-85 BV-dependent expression of the interleukin genes involved C-Fos/serum responsive element (C-Fos/SRE). CONCLUSIONS: The data suggest that the various immunopharmacological activities of OM-85 BV that have been described in clinical studies may be explained by its ability to induce expression of IL-6 and IL-8