Cognitive Behavioural Therapy versus Education of adult patients with chronic pain. A meta-analysis of the change of pain intensity post-intervention and after 6 months

Background: Sessions of Pain Management Programme in which an element of education of patients is involved are similar in structure to cognitive behaviour therapy (CBT) sessions. The key principles of education sessions primarily begin with establishing good rapport and explaining the rationale for therapy (Thorn et al. 2011). Systematic reviews comparing CBT with other treatments concluded that CBT is superior only to treatment as usual or waiting list in improving pain (Eccleston et al 2012). On the other hand Geneen et al (2015) concluded in a systematic review they couldn’t confidently conclude that education alone is effective in reducing pain intensity or related disability in chronic pain in adults. We have decided to review the literature for studies that compared CBT against Education head to head and evaluate the evidence. Aims: To compare the effectiveness of CBT versus Education of patients (Edu) regardless of its delivery method in reducing pain intensity just after the intervention and at 6 months follow up. Methods: Randomised Controlled Trials (RCTs) studies, including 20 or more participants in CBT and Edu arms for the management non-malignant chronic pain of adult patients (18- 65 years of age) were searched in PubMed, Cochrane, Science direct. Data on improvement of pain (measured as pain intensity using a numerical rating scale from 0-10 with 10 is the most severe pain, immediately post intervention and at after 6 months follow up) were extracted from the relevant studies. A meta-analysis approach was followed to estimate the total effect size of the difference between the two interventions in improving pain. Results: Out of initial eligible 5 studies that compared CBT against Education in the same sample of patients at the same time only 3 was qualified for this meta-analysis. These were Turner et al (2006) (n=72 CBT, 76 Edu), Thorn et al. (2011) (n=49 CBT, 34 Edu) and Carmody et al. (2013) (n=48 CBT, 50 Edu). All studies reported that patients were randomised to either CBT or Edu and pain intensity was similar between the two intervention groups at baseline (P>0.1). The overall effect size of the mean difference between CBT and Edu groups’ pain intensity suggested that there is no differences between the two interventions post-intervention (z=.044, P=0.66) or at 6 months follow up (z=-1.126, P=0.26). There was an intermediate level of heterogeneity (Q=4.22, P=0.12, I squared=52.60) but no publication bias among these three studies was identified. Conclusion: CBT and Education programmes of chronic pain management resulted in the same level of pain intensity reduction post-intervention and after 6 months follow up. The two interventions only slightly reduced the pain intensity score in the 3 samples studied which was statistically significant in one study only

Classical and Quantum Solitons in the Symmetric Space Sine-Gordon Theories

We construct the soliton solutions in the symmetric space sine-Gordon theories. The latter are a series of integrable field theories in 1+1-dimensions which are associated to a symmetric space F/G, and are related via the Pohlmeyer reduction to theories of strings moving on symmetric spaces. We show that the solitons are kinks that carry an internal moduli space that can be identified with a particular co-adjoint orbit of the unbroken subgroup H of G. Classically the solitons come in a continuous spectrum which encompasses the perturbative fluctuations of the theory as the kink charge becomes small. We show that the solitons can be quantized by allowing the collective coordinates to be time-dependent to yield a form of quantum mechanics on the co-adjoint orbit. The quantum states correspond to symmetric tensor representations of the symmetry group H and have the interpretation of a fuzzy geometric version of the co-adjoint orbit. The quantized finite tower of soliton states includes the perturbative modes at the base.Comment: 53 pages, additional comments and small errors corrected, final journal versio

Comparative Chromosome Maps of Neotropical Rodents Necromys lasiurus and Thaptomys nigrita (Cricetidae) Established by ZOO-FISH

This work presents chromosome homology maps between Mus musculus (MMU) and 2 South American rodent species from the Cricetidae group: Necromys lasiurus (NLA, 2n = 34) and Thaptomys nigrita (TNI, 2n = 52), established by ZOO-FISH using mouse chromosome-specific painting probes. Extending previous molecular cytogenetic studies in Neotropical rodents, the purpose of this work was to delineate evolutionary chromosomal rearrangements in Cricetidae rodents and to reconstruct the phylogenetic relationships among the Akodontini species. Our phylogenetic reconstruction by maximum parsimony analysis of chromosomal characters confirmed one consistent clade of all Neotropical rodents studied so far. In both species analyzed here, we observed the syntenic association of chromosome segments homologous to MMU 8/13, suggesting that this chromosome form is a synapomorphic trait exclusive to Neotropical rodents. Further, the previously described Akodontini-specific syntenic associations MMU 3/18 and MMU 6/12 were observed in N. lasiurus but not in T. nigrita, although the latter species is considered a member of the Akodontini tribe by some authors. Finally, and in agreement with this finding, N. lasiurus and Akodon serrensis share the derived fission of MMU 13, which places them as basal sister clades within Akodontini. Copyright (C) 2011 S. Karger AG, Base

Pedogenic pathways and deep weathering controls on soil organic carbon in Pacific Northwest forest soils

Characterizing the distribution and dynamics of organic carbon in soil is critical for quantifying changes in the global carbon cycle. In particular, weathering controls on near-surface and deep (>1 m) soil organic carbon (SOC) dynamics have been proposed but limited data prevents us from predicting SOC over topographically complex landscapes and quantifying how changes in climate and perturbations, such as wildfire or land management, influence SOC stocks. To advance our understanding of how weathering alters soil geochemistry and influences SOC storage, we synthesize previous data with a new analysis of the Siuslaw River soil chronosequence from terraces in the Oregon Coast Range, a region that harbors the richest SOC inventories in the continental US. We analyze how the relationships between soil geochemistry, physical properties, and SOC storage vary with weathering status and pathways across soils that span 0.041 to 990 kyr and vary in depth from 1 m to >10 m. To distinguish the key properties and processes influencing SOC storage at different depths, we break our analysis into three depth intervals: 0–30, 30–100, and >100 cm. Our results suggest that the processes that control SOC stocks vary systematically with time and depth owing to weathering impacts on soil properties and pedogenic development. At 30 kyr we observe a peak in SOC stock in the top 100 cm coincident with a peak in oxalate extractable Al and Fe concentrations, representing secondary poorly crystalline minerals, which is consistent with previous studies. We also observe a decline in shallow SOC stock for >30 kyr soils as poorly crystalline minerals are replaced by more stable crystalline forms and soils become clay dominated. At 120 kyr, SOC below 100 cm starts to contribute significantly to the total SOC profile inventory and by 990 kyr, this fraction composes >40% of the total SOC stock. Taken together, our results indicate that total SOC stock increases with soil age as the increased intensity of bedrock weathering deepens the critical zone, creating accommodation space for deep SOC storage. These findings reveal the intimate link between poorly crystalline minerals and SOC and suggest that systematic analysis of soil development in the critical zone provides a first-order constraint on SOC stocks

Challenges in clinical and laboratory diagnosis of androgen insensitivity syndrome: a case report

<p>Abstract</p> <p>Introduction</p> <p>Androgen is a generic term usually applied to describe a group of sex steroid hormones. Androgens are responsible for male sex differentiation during embryogenesis at the sixth or seventh week of gestation, triggering the development of the testes and penis in male fetuses, and are directed by the testicular determining factor: the gene <it>SRY </it>(sex determining region on Y chromosome) located on the short arm of chromosome Y. The differentiation of male external genitalia (penis, scrotum and penile urethra) occurs between the 9th and 13th weeks of pregnancy and requires adequate concentration of testosterone and the conversion of this to another more potent androgen, dihydrotestosterone, through the action of 5α-reductase in target tissues.</p> <p>Case presentation</p> <p>This report describes the case of a teenage girl presenting with a male karyotype, and aims to determine the extension of the mutation that affected the AR gene. A Caucasian girl aged 15 was referred to our laboratory for genetic testing due to primary amenorrhea. Physical examination, karyotype testing and molecular analysis of the androgen receptor were critical in making the correct diagnosis of complete androgen insensitivity syndrome.</p> <p>Conclusions</p> <p>Sex determination and differentiation depend on a cascade of events that begins with the establishment of chromosomal sex at fertilization and ends with sexual maturation at puberty, subsequently leading to fertility. Mutations affecting the <it>AR </it>gene may cause either complete or partial androgen insensitivity syndrome. The case reported here is consistent with complete androgen insensitivity syndrome, misdiagnosed at birth, and consequently our patient was raised both socially and educationally as a female. It is critical that health care providers understand the importance of properly diagnosing a newborn manifesting ambiguous genitalia. Furthermore, a child with a pseudohermaphrodite phenotype should always undergo adequate endocrine and genetic testing to reach a conclusive diagnosis before gender is assigned and surgical interventions are carried out. Our results show that extreme care must be taken in selecting the genetic tools that are utilized for the diagnosis for androgen insensitivity syndrome.</p

Quantifying erosion rates and weathering pathways that maximize soil organic carbon storage

Primary minerals that enter soils through bedrock weathering and atmospheric deposition can generate poorly crystalline minerals (PCM) that preferentially associate with soil organic carbon (SOC). These associations hinder microbial decomposition and the release of CO₂ from soils to the atmosphere, making them a critical geochemical control on terrestrial carbon abundance and persistence. Studies that explore these relationships are typically derived from soil chronosequences that experience negligible erosion and thus do not readily translate to eroding landscapes. Here, we propose a theoretical framework to estimate steady-state PCM density and stocks for hilly and mountainous settings by coupling geochemical and geomorphic mass balance equations that account for soil production from bedrock and dust, soil erosion, PCM formation from weathering, and the transformation of PCMs into crystalline phases. We calculate an optimal erosion rate for maximum PCM abundance that arises because PCMs are limited by insufficient weathering at faster erosion rates and loss via “ripening” into more crystalline forms at slower erosion rates. The optimal erosion rate for modeled hilltop soil is modulated by reaction rate constants that govern the efficiency of primary mineral weathering and PCM ripening. By comparing our analysis with global compilations of erosion and soil production rates derived from cosmogenic nuclides, we show that landscapes with slow-to-moderate erosion rates may be optimal for harboring abundant PCM stocks that can facilitate SOC sequestration and limit turnover. Given the growing array of erosion-topography metrics and the widespread availability of high-resolution topographic data, our framework demonstrates how weathering and critical zone processes can be coupled to inform landscape prioritization for persistent SOC storage potential across a broad range of spatial and temporal scales

A large animal model of RDH5-associated retinopathy recapitulates important features of the human phenotype

Pathogenic variants in retinol dehydrogenase 5 (RDH5) attenuate supply of 11-cis-retinal to photoreceptors leading to a range of clinical phenotypes including night blindness due to markedly slowed rod dark adaptation and in some patients, macular atrophy. Current animal models (such as Rdh5-/- mice) fail to recapitulate the functional or degenerative phenotype. Addressing this need for a relevant animal model we present a new domestic cat model with a loss-of-function missense mutation in RDH5 (c.542G > T; p.Gly181Val). As with patients, affected cats have a marked delay in recovery of dark adaptation. Additionally, the cats develop a degeneration of the area centralis (equivalent to the human macula). This recapitulates the development of macular atrophy that is reported in a subset of patients with RDH5 mutations and is shown in this paper in 7 patients with biallelic RDH5 mutations. There is notable variability in the age at onset of the area centralis changes in the cat, with most developing changes as juveniles but some not showing changes over the first few years of age. There is similar variability in development of macular atrophy in patients and while age is a risk factor, it is hypothesized that genetic modifying loci influence disease severity, and we suspect the same is true in the cat model. This novel cat model provides opportunities to improve molecular understanding of macular atrophy and test therapeutic interventions for RDH5-associated retinopathies

Investigating neuromagnetic brain responses against chromatic flickering stimuli by wavelet entropies

BACKGROUND: Photosensitive epilepsy is a type of reflexive epilepsy triggered by various visual stimuli including colourful ones. Despite the ubiquitous presence of colorful displays, brain responses against different colour combinations are not properly studied. METHODOLOGY/PRINCIPAL FINDINGS: Here, we studied the photosensitivity of the human brain against three types of chromatic flickering stimuli by recording neuromagnetic brain responses (magnetoencephalogram, MEG) from nine adult controls, an unmedicated patient, a medicated patient, and two controls age-matched with patients. Dynamical complexities of MEG signals were investigated by a family of wavelet entropies. Wavelet entropy is a newly proposed measure to characterize large scale brain responses, which quantifies the degree of order/disorder associated with a multi-frequency signal response. In particular, we found that as compared to the unmedicated patient, controls showed significantly larger wavelet entropy values. We also found that Renyi entropy is the most powerful feature for the participant classification. Finally, we also demonstrated the effect of combinational chromatic sensitivity on the underlying order/disorder in MEG signals. CONCLUSIONS/SIGNIFICANCE: Our results suggest that when perturbed by potentially epileptic-triggering stimulus, healthy human brain manages to maintain a non-deterministic, possibly nonlinear state, with high degree of disorder, but an epileptic brain represents a highly ordered state which making it prone to hyper-excitation. Further, certain colour combination was found to be more threatening than other combinations