Multidisciplinary treatment for chronic pain: a systematic review of interventions and outcomes

Objectives. To provide an overview of the effectiveness of multidisciplinary treatments of chronic pain and investigate about their differential effects on outcome in various pain conditions and of different multidisciplinary treatments, settings or durations. Methods. In this article, the authors performed a systematic review of all currently available randomized controlled trials (RCTs) fulfilling the inclusion criteria, by using a recently developed rating system aimed to assess the strength of evidence with regard to the methodological quality of the trials. Results. Compared with other non-disciplinary treatments, moderate evidence of higher effectiveness for multidisciplinary interventions was shown. In contrast to no treatment or standard medical treatment, strong evidence was detected in favour of multidisciplinary treatments. The evidence that comprehensive inpatient programmes were more beneficial that outpatient programmes was moderate. Fibromyalgia and chronic back pain patients tended to profit more substantially than patients with diverse origins or chronic pain diagnoses. No evidence was found that treatment variables, such as duration or programme components, were influential for the success of the intervention. Conclusion. A standard of multidisciplinary programmes should be internationally established to guarantee generally good outcomes in the treatment of chronic pain. Our results highlight the lack of quality of design, execution or reporting of many of the RCTs included in this article. Future studies should more specifically focus on differential effects of treatment components and patient variables, allowing the identification of subgroups, which most probably would profit from multidisciplinary pain programme

Open and / or laparoscopic surgical treatment of liver hydatic cysts

Hydatid disease is a severe parasitic disease with a widely ranging distribution. In the human being the liver is the most frequent organ affected. 1 The treatment should be individualized to the morphology, size, number and location of the cysts, that is why a variety of surgical operations have been advocated from complete resection like total pericystectomy or partial hepatectomy to laparoscopy to a minimally invasive procedures like percutaneous aspiration of cysts to conservative drug therapy. 3-4 This study compares laparoscopic versus open management of the hydatid cyst of liver the surgical approach to liver echinococcosis is still a controversial issue and shows our results of surgical treatment of liver hydatid cysts during a 3-years period

Surgical site infections in treatment of musculoskeletal tumors: experience from a single oncologic orthopedic institution

Objective: Limb-sparing surgery is the mainstay treatment for musculoskeletal tumors thanks to advances in surgical techniques, imaging modalities and multimodal therapies. As patients survive longer, plastic reconstructive procedures and revision surgery are increasingly required after tumor excision. Infection rate is reported to be up to 20% after prosthetic replacement and 30-44% after pelvic resection. The purpose of this study was to investigate the incidence of surgical site infections (SSIs), identifying the causative microrganisms related to specific surgical procedures and significant risk factors for SSIs. Methods: We retrospectively reviewed 723 interventions performed between 2009 and 2015 for oncological conditions. Non neoplastic lesions, aseptic wound complications, non-skeletally mature patients were excluded. Standardised antibiotic prophylaxis was used for different surgical procedures and maintained until removal of surgical drains. Results: Without considering tumor types and surgical sites, the overall infection rate was 8.7% (63/724). Infection occurred in prosthetic reconstruction with an incidence rate of 7.8%, whereas almost half of patients having undergone pelvic surgery got infected and about 20% of patients with spinal surgery and amputations were infected. Pelvic location, malignancy and radiotherapy were related to a major risk of SSI. The causative pathogens were detected in all examined cases. The most frequent pathogens detected by culture included Staphylococcus aureus (27 cases, 47.4%) and S. epidermidis (10 cases, 17.5%). Among the S. aureus cases, 10/27 cases (37%) were methicillin-resistant S. aureus (MRSA). Sixty-three out of 130 microbial isolations (47.7%) were nosocomial ALERT organisms. Conclusion: Oncologic orthopedic surgery is burdened by frequent and challenging SSIs because of extensive soft tissues dissection, long operative times and poor skin conditions. Patients are immunosuppressed and often have concomitant comorbidities predisposing to SSIs. Monitoring of local bacterial aetiology of SSIs could help orthopedic oncologic specialized centres in achieving the optimisation of antibiotic prophylactic regimens

Analysis of short-term blood pressure variability in pheochromocytoma/paraganglioma patients

Data on short-term blood pressure variability (BPV), which is a well-established cardiovascular prognostic tool, in pheochromocytoma and paraganglioma (PPGL) patients is still lack and conflicting. We retrospectively evaluated 23 PPGL patients referred to our unit from 2010 to 2019 to analyze 24 h ambulatory blood pressure monitoring (24-h ABPM)-derived markers of short-term BPV, before and after surgical treatment. PPGL diagnosis was assessed according to guidelines and confirmed by histologic examination. The 24-h ABPM-derived markers of short-term BPV included: circadian pressure rhythm; standard deviation (SD) and weighted SD (wSD) of 24-h, daytime, and night-time systolic and diastolic blood pressure (BP); average real variability (ARV) of 24-h, daytime, and night-time systolic and diastolic BP. 7 males and 16 females of 53 ± 18 years old were evaluated. After surgical resection of PPGL we found a significant decrease in 24-h systolic BP ARV (8.8 ± 1.6 vs. 7.6 ± 1.3 mmHg, p < 0.001), in 24-h diastolic BP ARV (7.5 ± 1.6 vs. 6.9 ± 1.4 mmHg, p = 0.031), and in wSD of 24-h diastolic BP (9.7 ± 2.0 vs 8.8 ± 2.1 mmHg, p = 0.050) comparing to baseline measurements. Moreover, baseline 24-h urinary metanephrines significantly correlated with wSD of both 24-h systolic and diastolic BP. Our study highlights as PPGL patients, after proper treatment, show a significant decrease in some short-term BPV markers, which might represent a further cardiovascular risk factor

Vascular Burden Predicts Gait, Mood, and Executive Function Disturbances in Older Adults with Mild Cognitive Impairment: Results from the Gait and Brain Study

International audienc

Explosions of water clusters in intense laser fields

Energetic, highly-charged oxygen ions, $O^{q+}$ ($q\leq 6$), are copiously produced upon laser field-induced disassembly of highly-charged water clusters, $(H_2O)_n$ and $(D_2O)_n$, $n\sim$ 60, that are formed by seeding high-pressure helium or argon with water vapor. $Ar_n$ clusters (n$\sim$40000) formed under similar experimental conditions are found undergo disassembly in the Coulomb explosion regime, with the energies of $Ar^{q+}$ ions showing a $q^2$ dependence. Water clusters, which are argued to be considerably smaller in size, should also disassemble in the same regime, but the energies of fragment O$^{q+}$ ions are found to depend linearly on $q$ which, according to prevailing wisdom, ought to be a signature of hydrodynamic expansion that is expected of much larger clusters. The implication of these observations on our understanding of the two cluster explosion regimes, Coulomb explosion and hydrodynamic expansion, is discussed. Our results indicate that charge state dependences of ion energy do not constitute an unambiguous experimental signature of cluster explosion regime.Comment: Submitted to Phys. Rev.