Relationship Between Rehabilitative Ultrasound Imaging and the Modified Prone Straight Leg Raise Test to Identify Multifidus Weakness

Background: Low back pain (LBP) is often associated with lumbar spinal instability (LSI). The multifidus muscle is considered a stabilizer of the spine and has been studied extensively with Rehabilitative Ultrasound Imaging (RUSI). There may be a relationshipbetween clinical signs of LSI, decreased cross-sectional area (CSA) of the multifidus and weakness. Having the ability to detect multifidus weakness without the use of RUSI may serve to be invaluable to the clinician in detecting multifidus weakness.Purpose: To investigate the relationship between the modified prone straight leg raise test (MPSLR) and CSA of the multifidusmuscle as measured by RUSI and to investigate the relationship between MPSLR and RUSI findings with the presence of low back pain symptoms that interfere with regular daily activities. Subjects: Participants consisted of two groups of subjects. One group (n=30, 87% male) comprised individuals in general good health, aged 18-55, without history of back pain. The second group (n=36, 56% male) comprised individuals aged 18-55, with history of low back pain within the past 12 months. Methodology: Subjects performed a MPSLR test to identify multifidus weakness. All subjects repeated the same test with concurrent RUSI to visualize the multifidusand measure its CSA. Results: A significant association between a positive MPSLR, asymmetry of the multifidus, and pain was observed (p r = .049, p = .696) was not observed. A sensitivity of 94% and a specificity of 63% was also discovered in the ability of the MPSLR test to detect asymmetry of themultifidus muscle within subjects. A positive MPSLR combined with a high Oswestry score of 25-30 further reinforced the probability of pain (p \u3c .001) Conclusion: The MPSLR test demonstrated a strong association between a positive test and asymmetry of themultifidus muscle within subjects. Clinical Relevance: The MPSLR test can be used to identify patients at risk for LBP symptoms due to asymmetrical changes in the multifidus muscle of the lumbar spine, and aid in directing an appropriate rehabilitation approach to those patients in need of specific multifidus exercise prescription

Mechanical support concept of the DEMO breeding blanket

The DEMO tokamak architecture is based on large vertical breeding blanket (BB) segments that are accessed from a maintenance hall above the tokamak and are vertically replaced through large upper ports of the vacuum vessel (VV). The feasibility of the BB segments mechanical supports is a prerequisite of this vertical segment architecture. Their design directly impacts on the removal kinematics and the remote handling operations required for release and engagement. The supports must withstand large forces acting on the BB in particular due to electromagnetic (EM) loads. At the same time, they must ensure a sufficiently precise positioning of the BB first wall. Their design also takes into account the significant thermal expansion of the blanket segments that are operated at high temperature avoiding excessive support reaction forces. The BB support concept described in this article does not require fasteners or electrical straps to the VV and therefore much reduces the complexity of the BB remote replacement – a valuable characteristic that would make this concept a milestone in meeting one of the goals defined for the DEMO project: to develop a maintainable fusion power plant design [1]. Each blanket segment is individually supported by the VV without any physical contact to the other blankets or in-vessel components. It relies instead on vertical pre-compression inside the VV due to obstructed thermal expansion and radial pre-compression due to the ferromagnetic force acting on the BB material in the toroidal magnetic field. The verification process did not identify show stoppers. Nonetheless, a further evolution of the concept is required including design improvements to mitigate the high stress levels found in the inboard blankets during plasma disruptions. The fact that no excessively high support reaction forces or large BB deflections were found suggests though that the further development of the concept could be successful

Regional diastolic function by tissue Doppler echocardiography in systemic sclerosis: correlation with clinical variables

The incidence of left ventricular (LV) diastolic dysfunction is increased in systemic sclerosis (SSc), while systolic dysfunction is present in a small percentage of patients. The aim of this study was to asses the LV "regional" diastolic abnormalities in SSc patients by the mean of Doppler tissue imaging (DTI). Echocardiographic echo-Doppler (DE) and DTI parameters were analyzed for 67 SSc patients: abnormal E/A ratio at DE was detected in 24, while abnormal e/a at DTI was observed in 41. A significant prevalence of DTI diastolic abnormalities in the segments reflecting longitudinal versus those reflecting radial LV motion was found. The segments of the basal regions of LV myocardium were significantly more involved than those of the middle portion. Linear correlation was observed between the extent of the diastolic abnormalities and the duration of disease. Longitudinal myocardial systolic velocities were significantly reduced in patients with abnormal e/a DTI

Is there a rational basis for cannabinoids research and development in ocular pain therapy? A systematic review of preclinical evidence

Background: Purpose of the present systematic review is to investigate preclinical evidence in favor of the working hypothesis of efficacy of cannabinoids in ocular pain treatment. Methods: Literature search includes the most relevant repositories for medical scientific literature from inception until November, 24 2021. Data collection and selection of retrieved records adhere to PRISMA criteria. Results: In agreement with a priori established protocol the search retrieved 2471 records leaving 479 results after duplicates removal. Eleven records result from title and abstract screening to meet the inclusion criteria; only 4 results are eligible for inclusion in the qualitative synthesis impeding meta-analysis. The qualitative analysis highlights the antinociceptive and anti-inflammatory efficacy of Δ8-tetrahydrocannabinol, cannabidiol and its derivative HU-308 and of new racemic CB1 allosteric ligand GAT211 and its enantiomers GAT228 and GAT229. Moreover, CB2R agonists RO6871304 and RO6871085 and CB2R ligand HU910 provide evidence of anti-inflammatory efficacy. CB2 agonist HU308 reduces of 241% uveitis-induced leukocyte adhesion and changes lipidome profile. Methodological and design issues raise concern of risk of bias and the amount of studies is too small for generalization. Furthermore, the ocular pain model used can resemble only inflammatory but not neuropathic pain. Conclusions: The role of the endocannabinoid system in ocular pain is underinvestigated, since only two studies assessing the effects of cannabinoid receptors modulators on pain behavior and other two on pain-related inflammatory processes are found. Preclinical studies investigating the efficacy of cannabinoids in ocular inflammatory and neuropathic pain models are needed to pave the way for clinical translation

A new estimation of the recent tropospheric molecular hydrogen budget using atmospheric observations and variational inversion

This paper presents an analysis of the recent tropospheric molecular hydrogen (H2) budget with a particular focus on soil uptake and European surface emissions. A variational inversion scheme is combined with observations from the RAMCES and EUROHYDROS atmospheric networks, which include continuous measurements performed between mid-2006 and mid-2009. Net H2 surface flux, then deposition velocity and surface emissions and finally, deposition velocity, biomass burning, anthropogenic and N2 fixation-related emissions were simultaneously inverted in several scenarios. These scenarios have focused on the sensibility of the soil uptake value to different spatio-temporal distributions. The range of variations of these diverse inversion sets generate an estimate of the uncertainty for each term of the H2 budget. The net H2 flux per region (High Northern Hemisphere, Tropics and High Southern Hemisphere) varies between −8 and +8 Tg yr−1. The best inversion in terms of fit to the observations combines updated prior surface emissions and a soil deposition velocity map that is based on bottom-up and top-down estimations. Our estimate of global H2 soil uptake is −59±9 Tg yr−1. Forty per cent of this uptake is located in the High Northern Hemisphere and 55% is located in the Tropics. In terms of surface emissions, seasonality is mainly driven by biomass burning emissions. The inferred European anthropogenic emissions are consistent with independent H2 emissions estimated using a H2/CO mass ratio of 0.034 and CO emissions within the range of their respective uncertainties. Additional constraints, such as isotopic measurements would be needed to infer a more robust partition of H2 sources and sinks

Comparison of four inverse modelling systems applied to the estimation of HFC-125, HFC-134a, and SF6 emissions over Europe

Hydrofluorocarbons (HFCs) are used in a range of industrial applications and have largely replaced previously used gases (CFCs and HCFCs). HFCs are not ozone-depleting but have large global warming potentials and are, therefore, reported to the United Nations Framework Convention on Climate Change (UNFCCC). Here, we use four independent inverse models to estimate European emissions of the two HFCs contributing the most to global warming (HFC-134a and HFC-125) and of SF6 for the year 2011. Using an ensemble of inverse models offers the possibility to better understand systematic uncertainties in inversions. All systems relied on the same measurement time series from Jungfraujoch (Switzerland), Mace Head (Ireland), and Monte Cimone (Italy) and the same a priori estimates of the emissions, but differed in terms of the Lagrangian transport model (FLEXPART, NAME), inversion method (Bayesian, extended Kalman filter), treatment of baseline mole fractions, spatial gridding, and a priori uncertainties. The model systems were compared with respect to the ability to reproduce the measurement time series, the spatial distribution of the posterior emissions, uncertainty reductions, and total emissions estimated for selected countries. All systems were able to reproduce the measurement time series very well, with prior correlations between 0.5 and 0.9 and posterior correlations being higher by 0.05 to 0.1. For HFC-125, all models estimated higher emissions from Spain + Portugal than reported to UNFCCC (median higher by 390 %) though with a large scatter between individual estimates. Estimates for Germany (+140 %) and Ireland (+850 %) were also considerably higher than UNFCCC, whereas the estimates for France and the UK were consistent with the national reports. In contrast to HFC-125, HFC-134a emissions from Spain + Portugal were broadly consistent with UNFCCC, and emissions from Germany were only 30 % higher. The data suggest that the UK over-reports its HFC-134a emissions to UNFCCC, as the model median emission was significantly lower, by 50 %. An overestimation of both HFC-125 and HFC-134a emissions by about a factor of 2 was also found for a group of eastern European countries (Czech Republic + Poland + Slovakia), though with less confidence since the measurement network has a low sensitivity to these countries. Consistent with UNFCCC, the models identified Germany as the highest national emitter of SF6 in Europe, and the model median emission was only 1 % lower than the UNFCCC numbers. In contrast, the model median emissions were 2–3 times higher than UNFCCC numbers for Italy, France, and Spain + Portugal. The country-aggregated emissions from the different models often did not overlap within the range of the analytical uncertainties formally given by the inversion systems, suggesting that parametric and structural uncertainties are often dominant in the overall a posteriori uncertainty. The current European network of three routine monitoring sites for synthetic greenhouse gases has the potential to identify significant shortcomings in nationally reported emissions, but a denser network would be needed for more reliable monitoring of country-wide emissions of these important greenhouse gases across Europe

VEGF-A/VEGFR-1 signalling and chemotherapy-induced neuropathic pain: therapeutic potential of a novel anti-VEGFR-1 monoclonal antibody

Background Neuropathic pain is a clinically relevant adverse effect of several anticancer drugs that markedly impairs patients' quality of life and frequently leads to dose reduction or therapy discontinuation. The poor knowledge about the mechanisms involved in neuropathy development and pain chronicization, and the lack of effective therapies, make treatment of chemotherapy-induced neuropathic pain an unmet medical need. In this context, the vascular endothelial growth factor A (VEGF-A) has emerged as a candidate neuropathy hallmark and its decrease has been related to pain relief. In the present study, we have investigated the role of VEGF-A and its receptors, VEGFR-1 and VEGFR-2, in pain signalling and in chemotherapy-induced neuropathy establishment as well as the therapeutic potential of receptor blockade in the management of pain. Methods Behavioural and electrophysiological analyses were performed in an in vivo murine model, by using selective receptor agonists, blocking monoclonal antibodies or siRNA-mediated silencing of VEGF-A and VEGFRs. Expression of VEGF-A and VEGFR-1 in astrocytes and neurons was detected by immunofluorescence staining and confocal microscopy analysis. Results In mice, the intrathecal infusion of VEGF-A (VEGF(165) isoforms) induced a dose-dependent noxious hypersensitivity and this effect was mediated by VEGFR-1. Consistently, electrophysiological studies indicated that VEGF-A strongly stimulated the spinal nociceptive neurons activity through VEGFR-1. In the dorsal horn of the spinal cord of animals affected by oxaliplatin-induced neuropathy, VEGF-A expression was increased in astrocytes while VEGFR-1 was mainly detected in neurons, suggesting a VEGF-A/VEGFR-1-mediated astrocyte-neuron cross-talk in neuropathic pain pathophysiology. Accordingly, the selective knockdown of astrocytic VEGF-A by intraspinal injection of shRNAmir blocked the development of oxaliplatin-induced neuropathic hyperalgesia and allodynia. Interestingly, both intrathecal and systemic administration of the novel anti-VEGFR-1 monoclonal antibody D16F7, endowed with anti-angiogenic and antitumor properties, reverted oxaliplatin-induced neuropathic pain. Besides, D16F7 effectively relieved hypersensitivity induced by other neurotoxic chemotherapeutic agents, such as paclitaxel and vincristine. Conclusions These data strongly support the role of the VEGF-A/VEGFR-1 system in mediating chemotherapy-induced neuropathic pain at the central nervous system level. Thus, treatment with the anti-VEGFR-1 mAb D16F7, besides exerting antitumor activity, might result in the additional advantage of attenuating neuropathic pain when combined with neurotoxic anticancer agents

VEGF-A/VEGFR-1 signalling and chemotherapy-induced neuropathic pain: therapeutic potential of a novel anti-VEGFR-1 monoclonal antibody

Abstract Background Neuropathic pain is a clinically relevant adverse effect of several anticancer drugs that markedly impairs patients’ quality of life and frequently leads to dose reduction or therapy discontinuation. The poor knowledge about the mechanisms involved in neuropathy development and pain chronicization, and the lack of effective therapies, make treatment of chemotherapy-induced neuropathic pain an unmet medical need. In this context, the vascular endothelial growth factor A (VEGF-A) has emerged as a candidate neuropathy hallmark and its decrease has been related to pain relief. In the present study, we have investigated the role of VEGF-A and its receptors, VEGFR-1 and VEGFR-2, in pain signalling and in chemotherapy-induced neuropathy establishment as well as the therapeutic potential of receptor blockade in the management of pain. Methods Behavioural and electrophysiological analyses were performed in an in vivo murine model, by using selective receptor agonists, blocking monoclonal antibodies or siRNA-mediated silencing of VEGF-A and VEGFRs. Expression of VEGF-A and VEGFR-1 in astrocytes and neurons was detected by immunofluorescence staining and confocal microscopy analysis. Results In mice, the intrathecal infusion of VEGF-A (VEGF165 isoforms) induced a dose-dependent noxious hypersensitivity and this effect was mediated by VEGFR-1. Consistently, electrophysiological studies indicated that VEGF-A strongly stimulated the spinal nociceptive neurons activity through VEGFR-1. In the dorsal horn of the spinal cord of animals affected by oxaliplatin-induced neuropathy, VEGF-A expression was increased in astrocytes while VEGFR-1 was mainly detected in neurons, suggesting a VEGF-A/VEGFR-1-mediated astrocyte-neuron cross-talk in neuropathic pain pathophysiology. Accordingly, the selective knockdown of astrocytic VEGF-A by intraspinal injection of shRNAmir blocked the development of oxaliplatin-induced neuropathic hyperalgesia and allodynia. Interestingly, both intrathecal and systemic administration of the novel anti-VEGFR-1 monoclonal antibody D16F7, endowed with anti-angiogenic and antitumor properties, reverted oxaliplatin-induced neuropathic pain. Besides, D16F7 effectively relieved hypersensitivity induced by other neurotoxic chemotherapeutic agents, such as paclitaxel and vincristine. Conclusions These data strongly support the role of the VEGF-A/VEGFR-1 system in mediating chemotherapy-induced neuropathic pain at the central nervous system level. Thus, treatment with the anti-VEGFR-1 mAb D16F7, besides exerting antitumor activity, might result in the additional advantage of attenuating neuropathic pain when combined with neurotoxic anticancer agents