What is the role of the placebo effect for pain relief in neurorehabilitation? Clinical implications from the Italian Consensus Conference on Pain in Neurorehabilitation

Background: It is increasingly acknowledged that the outcomes of medical treatments are influenced by the context of the clinical encounter through the mechanisms of the placebo effect. The phenomenon of placebo analgesia might be exploited to maximize the efficacy of neurorehabilitation treatments. Since its intensity varies across neurological disorders, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCP) summarized the studies on this field to provide guidance on its use. Methods: A review of the existing reviews and meta-analyses was performed to assess the magnitude of the placebo effect in disorders that may undergo neurorehabilitation treatment. The search was performed on Pubmed using placebo, pain, and the names of neurological disorders as keywords. Methodological quality was assessed using a pre-existing checklist. Data about the magnitude of the placebo effect were extracted from the included reviews and were commented in a narrative form. Results: 11 articles were included in this review. Placebo treatments showed weak effects in central neuropathic pain (pain reduction from 0.44 to 0.66 on a 0-10 scale) and moderate effects in postherpetic neuralgia (1.16), in diabetic peripheral neuropathy (1.45), and in pain associated to HIV (1.82). Moderate effects were also found on pain due to fibromyalgia and migraine; only weak short-term effects were found in complex regional pain syndrome. Confounding variables might have influenced these results. Clinical implications: These estimates should be interpreted with caution, but underscore that the placebo effect can be exploited in neurorehabilitation programs. It is not necessary to conceal its use from the patient. Knowledge of placebo mechanisms can be used to shape the doctor-patient relationship, to reduce the use of analgesic drugs and to train the patient to become an active agent of the therapy

Bistatic sonar and a novel form of variable depth sonar Sonar systems research study

SIGLEAvailable from British Library Document Supply Centre-DSC:DX190842 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Prevalence of urinary incontinence in a cohort of women with obesity

Urinary incontinence (UI) is frequently associated with obesity. The prevalence of the different UI types in women with obesity remains scarcely investigated and controversial. OBJECTIVE: The goal of this study was to investigate the prevalence of the different types of UI (stress urinary incontinence, SUI, urge, UUI, or mixed, MUI) in a large sample of female patients with obesity by means of a specific questionnaire and non-invasive tests. METHODS: In this observational study, 248 obese female patients (BMI≥30 Kg/m2, age: 62.8+10.9 years) admitted to hospital from April 2019 to September 2019 for a multidisciplinary rehabilitation program were recruited for this study. The International Consultation on Incontinence Questionnaire - short form (ICIQ-sf) was used to screen the presence of symptoms of UI and to differentiate the different UI types. Patients with ICIQ-sf score≥4, were asked to undertake the Pad Test for quantifying urine leaks under stress. RESULTS: 61.69% of our sample presented UI symptoms. The prevalence of UI appears to be lower in younger age groups (57% in 31-46 years of age and 52% in 47-62 years of age) and higher (69%) between 63 and 79 years of age. MUI was the most frequent form (57.5%), followed by UUI (21.5%) and SUI (20.9%). SUI was most prevalent in younger participants (31-46 years old). CONCLUSION: This study demonstrated that UI has a high prevalence in females with obesity and it is not an exclusive concern of older women. This high prevalence calls for specific rehabilitation interventions within multidisciplinary programs

Skeletal Muscle Mass, Sarcopenia and Rehabilitation Outcomes in Post-Acute COVID-19 Patients

The relationship between skeletal muscle mass at the beginning of the post-acute rehabilitation phase and rehabilitation outcomes has been scarcely investigated. The aim of this study was to investigate the impact of the existence of sarcopenia upon admission to a post-acute COVID-19 patient rehabilitation unit on body composition and functional and respiratory capacity at discharge. Thirty-four post-acute COVID-19 patients were referred to our Rehabilitation Unit from different COVID Hospitals in northern Italy. Body weight loss, body composition, handgrip strength, functional parameters, oxygen saturation and related perception of dyspnea in several positions were measured before and after a 28-day multidisciplinary rehabilitation program. Spirometry was performed only upon admission. The intervention included psychiatric support, cognitive behavioral therapy, nutritional therapy and physiotherapy, including aerobic and resistance training. Training volume was 45 min/session, 6 sessions/week. Upon admission, the prevalence of sarcopenia among our patients was 58%. In all of the 34 patients, we observed a trend of improvement in all of the respiratory, body composition, muscle strength and functional parameters considered. Monitoring muscle mass and strength in post-acute COVID-19 patients appears to be a key predictor of rehabilitation outcomes. Early diagnosis of sarcopenia therefore appears to be of paramount importance in the management of post-acute COVID-19 patients

Hardware primitives for the synthesis of multithreaded elastic systems

Elastic systems operate in a dataflow-like mode using a distributed scalable control and tolerating variable-latency computations. At the same time, multithreading increases the utilization of processing units and hides the latency of each operation by time-multiplexing operations of different threads in the datapath. This paper proposes a model to unify multithreading and elasticity. A new multithreaded elastic control protocol is introduced supported by low-cost elastic buffers that minimize the storage requirements without sacrificing performance. To enable the synthesis of multithreaded elastic architectures, new hardware primitives are proposed and utilized in two circuit examples to prove the applicability of the proposed approach.Peer Reviewe

Sexual function in pre- and post-menopausal women with obstructive sleep apnea syndrome

The objective of this study was to evaluate the female sexual function in relation to hormonal status in pre- and postmenopausal women with obstructive sleep apnea (OSA). A total of 43 premenopausal (mean age 42.1 +/- 4.9) and 58 postmenopausal (mean age 59.9 +/- 4.8) women were included in the study. All women filled out the Epworth sleepiness scale (ESS), the Beck Depression Inventory (BDI) and the Female Sexual Function Index (FSFI). Testosterone, estradiol and progesterone were measured. After polysomnography, women were allocated to a not-severe OSA group (Apnea-Hypopnea Index (AHI) 10-30) and a severe OSA group (AHI > 30). Healthy subjects comprised the control group. Severe OSA women in both pre- and post-menopausal group were found to have significantly lower mean FSFI score (16.5 +/- 4.0 and 16.9 +/- 4.7, respectively) compared with not-severe OSA (23.4 +/- 5.5, P < 0.01 and 21.8 +/- 7.5, P < 0.05) and control subjects (27.0 +/- 5.5, P < 0.01 and 24.0 +/- 6.7, P < 0.01). Progesterone, which was significantly lower in severe OSA premenopausal women (0.26 +/- 0.2) compared with not-severe OSA (0.55 +/- 0.14, P < 0.01) and control group (0.62 +/- 0.16, P < 0.01), correlated significantly with FSFI (r = 0.39, P < 0.01). Our study demonstrated that OSA is associated with sexual dysfunction in both premenopausal and postmenopausal women in a dose-related fashion. Regarding premenopausal women, our results indicated that progesterone may play a role in the association between OSA and female sexual dysfunction

The DJ-1 protein as a candidate biomarker in obstructive sleep apnea syndrome

Oxidative stress has a central role in the pathophysiology of obstructive sleep apnea syndrome (OSAS). The DJ-1 protein functions as a sensor of oxidative stress, acting both as a reactive oxygen species scavenger (ROS) and an antioxidative response regulator. The aim of our study is to determine the serum levels of DJ-1 in OSAS patients and assess possible correlations with their clinical, demographical, and biochemical characteristics. The study included 120 subjects from the Sleep Disorder Laboratory of the University Hospital of Thessaly (100 males vs 20 females, mean age 48 +/- 10, Apnea-Hypopnea Index (AHI) > 5 episodes per hour of sleep). Subjects underwent full-night polysomnography (PSG) followed by morning blood sampling. Serum DJ-1 levels were determined via ELISA kits. Statistical analysis was performed using SPSS 19. The median DJ-1 levels were 56.7 ng/mL (IQR, 34.9-99.3 ng/mL). Statistically significant correlations were detected between DJ-1's levels and AHI (Spearman's rho = 0.189, P = 0.04), Desaturation Index (DI; Spearman's rho = 0.239, P = 0.012), and serum low-density lipoprotein (LDL) (Spearman's rho = -0.205, P = 0.042). DJ-1 may be a useful biomarker in OSAS due to its correlations with AHI and DI. The correlation with serum LDL warrants further investigation regarding possible implications in OSAS patients' cardiovascular comorbidities