Chronic pain: the importance of a sex and gender-based approach to treatment

Twenty-eight million women in the United States suffer from chronic pain. 70% of patients seeking treatment for chronic pain are women, and are found to return to pain clinics thirty-two times more frequently than men. These findings indicate that women experience insuficient pain relief following intervention. Given that 80% of pain research has been conducted on men, most knowledge of pain pathways in women are extrapolations, shedding light on the ineficiencies of current treatment algorithms, and the importance of a sex and gender-based approach to chronic pain. The biochemistry and physiology of the pain pathway, as well as the pharmacokinetics and pharmacodynamics of medications used to remedy pain responses, are signifcantly different between men and women. Low-estradiol states result in a reduction in both mu-opioid receptor recruitment and basal activation, leading to significant hyperalgesia and sensitivity to chronic pain in women as compared to men. Further compounding the dichotomy between the chronic pain response is the response to analgesics. Women have lower levels of glucuronidation, higher volumes of distribution, and lower clearance of commonly administered analgesics as compared to men. Psychosocial factors such as gender roles, expectations surrounding pain, and coping strategies also determine how pain is perceived and ultimately influence how pain is treated. These findings are just beginning to shed light on the ways in which women and men respond differently in vivo to pain. However, the decision to treat women and men as separate entities with respect to pain management should not be a binary one. While patients should be treated as individuals, pre-menopausal, post-menopausal and transgender women, should all be met with an approach that takes into account the sex and gender differences that exist. Pain management physicians should take heed of these complex differences and utilize a sex and gender-based approach while managing patients.https://jdc.jefferson.edu/sexandgenderhealth/1025/thumbnail.jp

Microstructure Development and Phase Evolution of Alumina- mullite Nanocomposite

In this work, alumina-mullite composites (5-15 vol.%) were prepared using sol-gel derived alumina composite nanopowders. The results revealed the formation of intragranular and intergranular mullites inside and between the alumina grains, respectively. Accordingly, the intragranular mullites (average grain size, 0.3 ?m) were smaller than the intergranular mullites (average grain size, 0.5 ?m). Moreover, the alumina grains (average grain size, 1.0 ?m) are larger than the mullites. Meanwhile, the mullites showed positive results in the prevention of the alumina grains growth and the retardation of densification. The relative density of alumina-15 vol.% mullite that was sintered at 1650?C for 2 h, was obtained as 98.7 %. After sintering at 1750?C for 2 h, the mullite was decomposed

Chronic Pain Management: The Importance of Sex and Gender-Based Approach

Presented as a poster at Indiana Society of Anesthesiologists Annual Meeting 2020

Diorganotin(IV) complexes with 2-furancarboxylic acid hydrazone derivative of benzoylacetone : synthesis, X-ray structure, antibacterial activity, DNA cleavage and molecular docking

Two new diorganotin(IV) complexes, Me2SnL and Ph2SnL, have been synthesized from the reaction of Me2SnCl2 and Ph2SnCl2 with the hydrazone H2L [H2L \ubc (Furan-2-yl) (5-hydroxy-3-methyl-5-phenyl-4,5- dihydro-1H-pyrazol-1-yl)-methanone] derived from furan-2-carbohydrazide and benzoylacetone. The new compounds have been characterized by elemental and spectroscopic analyses. The crystal structures of the monohydrate form of the ligand and of the Me2SnL derivative have been also determined by X-ray crystallography. Experimental evidences confirm the existence of the hydrazone ligand exclusively in cyclic form in both solution and solid state. On coordination to tin the hydrazone undergoes a ring opening reaction and a doubly deprotonation to act as a tridentate ligand via imine nitrogen and enolic oxygens. The tin atom in the complexes is five coordinate with geometry between square-pyramidal and trigonal-bipyramidal. The in vitro antibacterial activity of ligand and its complexes has been evaluated against Gram-positive (Bacillus subtilis and Staphylococcus aureus) and Gram-negative (Escherichia coli and Pseudomonas aeruginosa) bacteria. The interaction between compounds with bacterial DNA was also studied by molecular docking. Our findings indicate that diphenyltin(IV) complex, by binding to DNA via minor groove to TATA sequence in genes upstream, has good activities along with the standard antibacterial drugs. Our agarose-gel electrophoresis experiments show that the ligand exert DNA cleavage, while Me2SnL and Ph2SnL did not

Morphological study and description of Anopheles (Anopheles) persiensis, a member of the Maculipennis Group (Diptera: Culicidae: Anophelinae) in Iran

The morphology of the adults, egg, larva and pupa of Anopheles persiensis Linton, Sedaghat & Harbach, an Iranian member of the Holarctic Maculipennis Group, was studied and compared with the morphology of the closely related and sympatric A. maculipennis Meigen. Anopheles persiensis was formally recognized based on DNA evidence and egg morphology. The fourth member of the group, Anopheles persiensis, is described in detail and the egg illustrated using scanning electron microscopy

Biomechanical analysis of temporomandibular joint dynamics based on real-time magnetic resonance imaging

Aim: The traditional hinge axis theory of temporomandibular joint (TMJ) dynamics is increasingly being replaced by the theory of instantaneous centers of rotation (ICR). Typically, ICR determinations are based on theoretical calculations or three-dimensional approximations of finite element models. Materials and methods: With the advent of real-time magnetic resonance imaging (MRI), natural physiologic movements of the TMJ may be visualized with 15 frames per second. The present study employs real-time MRI to analyze the TMJ biomechanics of healthy volunteers during mandibular movements, with a special emphasis on horizontal condylar inclination (HCI) and ICR pathways. The Wilcoxon rank sum test was used to comparatively analyze ICR pathways of mandibular opening and closure. Results: Mean HCI was 34.8 degrees (± 11.3 degrees) and mean mandibular rotation was 26.6 degrees (± 7.2 degrees). Within a mandibular motion of 10 to 30 degrees, the resulting x- and y-translation during opening and closure of the mandible differed significantly (10 to 20 degrees, x: P = 0.02 and y: P 30 degrees showed no significant differences in x- and y-translation. Near occlusion movements differed only for y-translation (P < 0.01). Conclusion: Real-time MRI facilitates the direct recording of TMJ structures during physiologic mandibular movements. The present findings support the theory of ICR. Statistics confirmed that opening and closure of the mandible follow different ICR pathways, which might be due to muscular activity discrepancies during different movement directions. ICR pathways were similar within maximum interincisal distance (MID) and near occlusion (NO), which might be explained by limited extensibility of tissue fibers (MID) and tooth contact (NO), respectively

Analysis of enriched rare variants in JPH2-encoded junctophilin-2 among Greater Middle Eastern individuals reveals a novel homozygous variant associated with neonatal dilated cardiomyopathy.

Junctophilin-2 (JPH2) is a part of the junctional membrane complex that facilitates calcium-handling in the cardiomyocyte. Previously, missense variants in JPH2 have been linked to hypertrophic cardiomyopathy; however, pathogenic "loss of function" (LOF) variants have not been described. Family-based genetic analysis of GME individuals with cardiomyopathic disease identified an Iranian patient with dilated cardiomyopathy (DCM) as a carrier of a novel, homozygous single nucleotide insertion in JPH2 resulting in a stop codon (JPH2-p.E641*). A second Iranian family with consanguineous parents hosting an identical heterozygous variant had 2 children die in childhood from cardiac failure. To characterize ethnicity-dependent genetic variability in JPH2 and to identify homozygous JPH2 variants associated with cardiac disease, we identified variants in JPH2 in a worldwide control cohort (gnomAD) and 2 similar cohorts from the Greater Middle East (GME Variome, Iranome). These were compared against ethnicity-matched clinical whole exome sequencing (WES) referral tests and a case cohort of individuals with hypertrophic cardiomyopathy (HCM) based on comprehensive review of the literature. Worldwide, 1.45% of healthy individuals hosted a rare JPH2 variant with a significantly higher proportion among GME individuals (4.45%); LOF variants were rare overall (0.04%) yet were most prevalent in GME (0.21%). The increased prevalence of LOF variants in GME individuals was corroborated among region-specific, clinical WES cohorts. In conclusion, we report ethnic-specific differences in JPH2 rare variants, with GME individuals being at higher risk of hosting homozygous LOF variants. This conclusion is supported by the identification of a novel JPH2 LOF variant confirmed by segregation analysis resulting in autosomal recessive pediatric DCM due to presumptive JPH2 truncation

International consensus statement on allergy and rhinology: Allergic rhinitis – 2023

Background In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR-Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR-Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence-based findings and recommendation from the full document. Methods ICAR-Allergic Rhinitis 2023 employed established evidence-based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work. Results ICAR-Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost. Conclusion The ICAR-Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment