Comprehensiveness and validity of a multidimensional assessment in patients with chronic low back pain: a prospective cohort study

Background: Chronic low back pain is a multidimensional syndrome affecting physical activity and function, health-related quality of life and employment status. The aim of the study was to quantify the cross-sectional and longitudinal validity of single measurement scales in specific construct domains and to examine how they combine to build a comprehensive outcome, covering the complex construct of chronic low back pain before and after a standardized interdisciplinary pain program. Methods: This prospective cohort study assessed 177 patients using the Short Form 36 (SF-36), the Multidimensional Pain Inventory (MPI), the Symptom Checklist-90-Revised (SCL-90-R), the Oswestry Disability Index (ODI), and 2 functional performance tests, the Back Performance Scale (BPS) and the 6-Minute Walking Distance (6MWD). The comprehensiveness and overlap of the constructs used were quantified cross-sectionally and longitudinally by bivariate correlations, exploratory factor analysis, and effect sizes. Results: The mean age of the participants was 48.0 years (+/− 12.7); 59.3% were female. Correlations of baseline scores ranged from r = − 0.01 (BPS with MPI Life control) to r = 0.76 (SF-36 Mental health with MPI Negative mood). SF-36 Physical functioning correlated highest with the functional performance tests (r = 0.58 BPS, 0.67 6MWD) and ODI (0.56). Correlations of change scores (difference of follow-up – baseline score) were consistent but weaker. Factor analysis revealed 2 factors: “psychosocial” and “pain & function” (totally explained variance 44.0–60.9%). Psychosocial factors loaded strongest (up to 0.89 SCL-90-R) on the first factor, covering 2/3 of the explained variance. Pain and function (ing) loaded more strongly on the second factor (up to 0.81 SF-36 Physical functioning at follow-up). All scales showed improvements, with effect sizes ranging from 0.16–0.67. Conclusions: Our results confirm previous findings that the chronic low back pain syndrome is highly multifactorial and comprises many more dimensions of health and quality of life than merely back-related functioning. A comprehensive outcome measurement should include the predominant psychosocial domain and a broad spectrum of measurement constructs in order to assess the full complexity of the chronic low back syndrome. Convergence and divergence of the scales capture the overlapping contents and nuances within the constructs

Cluster Headache and the Comprehension Paradox

Patients with primary headache disorders such as cluster headache cycle between being entirely healthy and almost completely incapacitated. Sick leave or reduced performance due to headache attacks demands flexibility by their social counterparts. The objective of this study is to test the hypothesis that headache patients cause frustration that grows with the times colleagues have to take over their work. In this study, we analysed cluster headache patients’ answers to an online questionnaire. Participants self-reported their number of sick days, the number of days on which leisure activities were missed and whether they felt understood by colleagues and family. We then investigated the correlation between the number of sick days and the proportion of patients feeling understood by colleagues and friends. We found that feeling understood by colleagues and friends decreases with a growing number of sick days. However, when sick days accrue further, this proportion increases again. The number of sick days correlates similarly with both colleagues’ and friends’ understanding. The number of cluster headache patients feeling understood by others decreases with an increasing number of sick days. Their social circles’ frustration with the patients’ failure to meet obligations and expectations are a likely reason. With a growing number of sick days, however, the portion of patients feeling understood rises again despite patients meeting others’ expectations even less. This ‘comprehension paradox’ implies the influence of other factors. We suspect that growing numbers of sick days foster understanding as the disability of the disease becomes increasingly apparent

Echinococcus multilocularis in south-eastern Europe (Romania)

Echinococcus multilocularis, the causative agent of alveolar echinococcosis (AE) in humans, has been found in 4.8% of 561 red foxes originating from various regions of Romania. Infected foxes were identified in 8 of 15 counties with average prevalence rates between 1.7% and 14.6%. In previous studies, E. multilocularis was not found in 535 foxes from three counties, but larval stages (metacestodes) were present in four species of rodents. Furthermore, AE was diagnosed in two patients. Experiences from other European regions indicate that several factors (such as increasing fox populations with higher parasite prevalences and urban cycles of the parasite) may result in an increased infection risk for human

CGRP-MoAbs – «game changer» in der Migräneprophylaxe?

Die Prophylaxe der Migräne ist kein einfaches Unterfangen. Aus der Vielzahl der verwendeten Substanzklassen lässt sich schliessen, dass keine einzige einen hinreichenden Nutzen für schwer Betroffene bringt. In der Vergangenheit wurden Migräneprophylaktika eher zufällig entdeckt. Beispielsweise zeigten Betablocker als «Nebenwirkung» einen migräneprophylaktischen Effekt und wurden erst dann systematisch untersucht. Dies änderte sich, als Veränderungen der Serumkonzentration des Neuropeptids «Calcitonin gene related polypeptide» (CGRP) während Migräneanfällen in den späten 80er Jahren [1] beschrieben wurde. Basierend auf den Erkenntnissen dieser pathophysiologischen Studien wurden Antagonisten gegen Bestandteile des CGRP-Systems für die Migränetherapie entwickel

Occipital transcranial direct current stimulation in episodic migraine patients: effect on cerebral perfusion

Cerebral blood flow differs between migraine patients and healthy controls during attack and the interictal period. This study compares the brain perfusion of episodic migraine patients and healthy controls and investigates the influence of anodal transcranial direct current stimulation (tDCS) over the occipital cortex. We included healthy adult controls and episodic migraineurs. After a 28-day baseline period and the baseline visit, migraine patients received daily active or sham anodal tDCS over the occipital lobe for 28 days. All participants underwent a MRI scan at baseline; migraineurs were also scanned shortly after the stimulation period and about five months later. At baseline, brain perfusion of migraine patients and controls differed in several areas; among the stimulated areas, perfusion was increased in the cuneus of healthy controls. At the first visit, the active tDCS group had an increased blood flow in regions processing visual stimuli and a decreased perfusion in other areas. Perfusion did not differ at the second follow-up visit. The lower perfusion level in migraineurs in the cuneus indicates a lower preactivation level. Anodal tDCS over the occipital cortex increases perfusion of several areas shortly after the stimulation period, but not 5 months later. An increase in the cortical preactivation level could mediate the transient reduction of the migraine frequency.Trial registration: NCT03237754 (registered at clincicaltrials.gov; full date of first trial registration: 03/08/2017)

De novo steroidogenesis in tumor cells drives bone metastasis and osteoclastogenesis

Osteoclasts play a central role in cancer-cell-induced osteolysis, but the molecular mechanisms of osteoclast activation during bone metastasis formation are incompletely understood. By performing RNA sequencing on a mouse breast carcinoma cell line with higher bone-metastatic potential, here we identify the enzyme CYP11A1 strongly upregulated in osteotropic tumor cells. Genetic deletion of Cyp11a1 in tumor cells leads to a decreased number of bone metastases but does not alter primary tumor growth and lung metastasis formation in mice. The product of CYP11A1 activity, pregnenolone, increases the number and function of mouse and human osteoclasts in vitro but does not alter osteoclast-specific gene expression. Instead, tumor-derived pregnenolone strongly enhances the fusion of pre-osteoclasts via prolyl 4-hydroxylase subunit beta (P4HB), identified as a potential interaction partner of pregnenolone. Taken together, our results demonstrate that Cyp11a1-expressing tumor cells produce pregnenolone, which is capable of promoting bone metastasis formation and osteoclast development via P4HB

PERICLES Deliverable 4.3:Content Semantics and Use Context Analysis Techniques

The current deliverable summarises the work conducted within task T4.3 of WP4, focusing on the extraction and the subsequent analysis of semantic information from digital content, which is imperative for its preservability. More specifically, the deliverable defines content semantic information from a visual and textual perspective, explains how this information can be exploited in long-term digital preservation and proposes novel approaches for extracting this information in a scalable manner. Additionally, the deliverable discusses novel techniques for retrieving and analysing the context of use of digital objects. Although this topic has not been extensively studied by existing literature, we believe use context is vital in augmenting the semantic information and maintaining the usability and preservability of the digital objects, as well as their ability to be accurately interpreted as initially intended.PERICLE

Macroscopic Manifestation of Domain-wall Magnetism and Magnetoelectric Effect in a N\'eel-type Skyrmion Host

We report a magnetic state in GaV$_4$Se$_8$ which emerges exclusively in samples with mesoscale polar domains and not in polar mono-domain crystals. Its onset is accompanied with a sharp anomaly in the magnetic susceptibility and the magnetic torque, distinct from other anomalies observed also in polar mono-domain samples upon transitions between the cycloidal, the N\'eel-type skyrmion lattice and the ferromagnetic states. We ascribe this additional transition to the formation of magnetic textures localized at structural domain walls, where the magnetic interactions change stepwise and spin textures with different spiral planes, hosted by neighbouring domains, need to be matched. A clear anomaly in the magneto-current indicates that the domain-wall-confined magnetic states also have strong contributions to the magnetoelectric response. We expect polar domain walls to commonly host such confined magnetic edge states, especially in materials with long wavelength magnetic order

Softened magnetic excitations in the s = 3/2 distorted triangular antiferromagnet alpha-CaCr2O4

The spin dynamics and magnetic excitations of the slightly distorted triangular s = 3/2 system alpha-CaCr2O4 are investigated by means of Raman spectroscopy and electron spin resonance (ESR) to elucidate its peculiar magnetic properties. Two-magnon excitations in circular RL symmetry show a multi-maximum structure with a dominant spectral weight at low energies. The temperature dependence of the ESR linewidth is described by a critical broadening DeltaHpp(T) ~ (T - T_N)^{-p} with the exponent p = 0.30(3) - 0.38(5) for temperatures above T_N = 42.6 K. The exponent is much smaller than that of other s = 3/2 triangular lattices. This is ascribed to soft roton-like modes, indicative of the instability of a helical 120{\deg} phase. As an origin we discuss a complex spin topology formed by four inequivalent nearest neighbor and sizable next-nearest neighbor interactions.Comment: 7 pages, 4 figure

Rare Copy Number Variants in \u3cem\u3eNRXN1\u3c/em\u3e and \u3cem\u3eCNTN6\u3c/em\u3e Increase Risk for Tourette Syndrome

Tourette syndrome (TS) is a model neuropsychiatric disorder thought to arise from abnormal development and/or maintenance of cortico-striato-thalamo-cortical circuits. TS is highly heritable, but its underlying genetic causes are still elusive, and no genome-wide significant loci have been discovered to date. We analyzed a European ancestry sample of 2,434 TS cases and 4,093 ancestry-matched controls for rare (\u3c 1% frequency) copy-number variants (CNVs) using SNP microarray data. We observed an enrichment of global CNV burden that was prominent for large (\u3e 1 Mb), singleton events (OR = 2.28, 95% CI [1.39–3.79], p = 1.2 × 10−3) and known, pathogenic CNVs (OR = 3.03 [1.85–5.07], p = 1.5 × 10−5). We also identified two individual, genome-wide significant loci, each conferring a substantial increase in TS risk (NRXN1 deletions, OR = 20.3, 95% CI [2.6–156.2]; CNTN6 duplications, OR = 10.1, 95% CI [2.3–45.4]). Approximately 1% of TS cases carry one of these CNVs, indicating that rare structural variation contributes significantly to the genetic architecture of TS