The effect of visual stimulation via the eyeglass display and the perception of pain

Hospitalization involves anxiety and pain for many people. Unfamiliar hospital settings, various diagnostic and therapeutic procedures, and the sight and sounds of medical procedures exacerbate pain and anxiety. By blocking off the anxiety-inducing sights and sounds of the hospital surroundings and creating a pleasant environment, an eyeglass display might be able to change the sensation and perception of pain. In this randomized, controlled, crossover study, 72 healthy university student volunteers were asked to wear a light-weight eyeglass that projected a feeling of watching a 52-inch television screen at 6 1/2 feet in distance while pain was produced by a modified tourniquet technique. Subjects were randomly assigned to participate in a V-session or B-session first, with subsequent cross-over. In a V-session, subjects were instructed to wear the eyeglass and watch the soundless display of natural scenery during the inflation. In a B-session, the eyeglass that subjects wore would project a static blank screen. During V-sessions, there was a significant increase in pain threshold (p < 0.001) and pain tolerance (p < 0.001). The degree of immersion was positively correlated with improvement in pain threshold, whereas the anxiety level was negatively correlated with improvement in pain threshold. These findings have implications for using visual stimulation as a positive adjunct to other methods of pain relief and for different pain conditions. This study was considered to be the pioneer use of visual stimulation in the local Chinese community as an adjunct to pain relief.published_or_final_versio

Large-Scale Whole-Genome Sequencing Reveals the Genetic Architecture of Primary Membranoproliferative GN and C3 Glomerulopathy

BACKGROUND: Primary membranoproliferative GN, including complement 3 (C3) glomerulopathy, is a rare, untreatable kidney disease characterized by glomerular complement deposition. Complement gene mutations can cause familial C3 glomerulopathy, and studies have reported rare variants in complement genes in nonfamilial primary membranoproliferative GN. METHODS: We analyzed whole-genome sequence data from 165 primary membranoproliferative GN cases and 10,250 individuals without the condition (controls) as part of the National Institutes of Health Research BioResource–Rare Diseases Study. We examined copy number, rare, and common variants. RESULTS: Our analysis included 146 primary membranoproliferative GN cases and 6442 controls who were unrelated and of European ancestry. We observed no significant enrichment of rare variants in candidate genes (genes encoding components of the complement alternative pathway and other genes associated with the related disease atypical hemolytic uremic syndrome; 6.8% in cases versus 5.9% in controls) or exome-wide. However, a significant common variant locus was identified at 6p21.32 (rs35406322) (P=3.29×10−8; odds ratio [OR], 1.93; 95% confidence interval [95% CI], 1.53 to 2.44), overlapping the HLA locus. Imputation of HLA types mapped this signal to a haplotype incorporating DQA1*05:01, DQB1*02:01, and DRB1*03:01 (P=1.21×10−8; OR, 2.19; 95% CI, 1.66 to 2.89). This finding was replicated by analysis of HLA serotypes in 338 individuals with membranoproliferative GN and 15,614 individuals with nonimmune renal failure. CONCLUSIONS: We found that HLA type, but not rare complement gene variation, is associated with primary membranoproliferative GN. These findings challenge the paradigm of complement gene mutations typically causing primary membranoproliferative GN and implicate an underlying autoimmune mechanism in most cases

The International HapMap Project

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/62838/1/nature02168.pd

Germline selection shapes human mitochondrial DNA diversity.

Approximately 2.4% of the human mitochondrial DNA (mtDNA) genome exhibits common homoplasmic genetic variation. We analyzed 12,975 whole-genome sequences to show that 45.1% of individuals from 1526 mother-offspring pairs harbor a mixed population of mtDNA (heteroplasmy), but the propensity for maternal transmission differs across the mitochondrial genome. Over one generation, we observed selection both for and against variants in specific genomic regions; known variants were more likely to be transmitted than previously unknown variants. However, new heteroplasmies were more likely to match the nuclear genetic ancestry as opposed to the ancestry of the mitochondrial genome on which the mutations occurred, validating our findings in 40,325 individuals. Thus, human mtDNA at the population level is shaped by selective forces within the female germ line under nuclear genetic control, which ensures consistency between the two independent genetic lineages.NIHR, Wellcome Trust, MRC, Genomics Englan

The effect of visual stimuli on pain threshold and tolerance

For many hospital patients, the experience brings pain and anxiety. Unfamiliar surroundings, various diagnostic and therapeutic procedures, and the sight and sounds of medical procedures exacerbate pain and anxiety. To block off the anxiety-inducing sights and sounds of hospital surroundings and create a pleasing environment, the therapeutic potential of visual stimulation as a nursing intervention was investigated. In a randomized, controlled, cross-over study, pain was produced by a modified tourniquet technique in 46 healthy volunteers. Subjects were randomly allocated to two groups (Group V and Group B) with subsequent cross-over. Those in Group V watched a soundless video display of natural scenery during tourniquet inflation, whereas in Group B subjects watched a static blank screen. Pain threshold was defined as the time when subjects reported the first detectable pain, whereas pain tolerance was the time the pain was reported to be intolerable and deflation of the tourniquet was requested. With the use of visual stimuli, there was a significant increase in pain threshold (P < 0.05) and pain tolerance (P < 0.01). Gender and the sequence of visual stimuli did not have any significant effect on pain threshold and pain tolerance. Further studies specifically addressing level of anxiety and physiological data correlated with pain scores and visual stimuli are needed. The findings have implications for nurses and other healthcare professionals to use various visual stimuli as positive adjuncts to other methods of pain relief and for different pain conditions in clinical areas. © 2002 Blackwell Science Ltd.link_to_subscribed_fulltex

Expression of leptin and leptin receptors in gestational trophoblastic diseases

To investigate the expression profile of leptin and leptin receptors in gestational trophoblastic diseases (GTDs). Using immunohistochemical staining on archival paraffin-embedded tissue sections, we studied the expression of leptin and leptin receptor in hydatidiform moles, with gestational age-matched normal first-trimester placenta used as control. A total of 38 cases of hydatidiform moles were studied, including 20 complete moles (CHMs) and 18 partial moles (PHMs). Among them, 10 cases of the CHM group and 8 cases of the PHM group subsequently developed residual trophoblastic disease (RTD). In addition, two cases of choriocarcinoma and three cases of placental site trophoblastic tumor (PSTT) were also studied. Reverse transcriptase-polymerase chain reaction (RT-PCR) was further performed using RNA extracted from frozen tissue (five CHMs, four PHMs and nine normal first-trimester placenta) to study the expression of leptin and individual leptin receptor isoforms at the transcription level. In all tissue sections, immunostaining signal was shown in the cytoplasmic compartment of cytotrophoblasts and syncytiotrophoblasts, with much stronger staining in the former. Significantly higher immunostaining intensity was shown for both leptin (P 0.05). In the choriocarcinoma and PSTT cases, intense immunostaining was found in the tumor cells. RT-PCR revealed that the expression of leptin and all leptin receptor isoforms were significantly higher in both CHMs and PHMs than in normal placenta (P < 0.05). There is up-regulated expression of leptin and leptin receptor in GTDs. However, there is no obvious correlation with the development of RTD. The exact role played by leptin and its receptors in the pathogenesis of GTDs awaits further investigations. © 2004 Elsevier Inc. All rights reserved.link_to_subscribed_fulltex

Modified symbolic play test for Oriental children

Background: Symbolic play test (SPT) is a simple test for screening preverbal language in children. This test had been validated in English-speaking children. However, the toys may not be useful for other cultures such as Orientals like Chinese, Japanese, Koreans or Thais as they use chopsticks and bowls as eating utensils rather than spoon, fork or knife. The aim of this study was to find a set of miniature toys suitable for children of Oriental ethnic origin in order to get a reliable language test. Methods: Altogether 140 children were recruited into this study. This included 62 control children and 78 with idiopathic developmental delay. The original SPT was applied together with an additional set of miniature toys appropriate for Oriental culture (i.e. modified version of SPT) by modifying play items in situations 3 and 4 to suit the Chinese culture. The authors replaced the knife, fork and plate with chopsticks and bowl in situation 3 and replaced the tractor and trailer with train carts in situation 4. For the ease of comparison, the authors segregated the age groups with the same age range as the original English-based SPT: less than 20 months (N = 11); 21-30 months (N = 45); 31-40 months (N = 43); 41-50 months (N = 21), and more than 50 months (N = 4). Results: The mean scores of the cohort was higher (14.83) with the modified version of SPT than when the original SPT was used (13.64). A statistically significant increase in the mean score in situation 3 (3.67-3.24 = 0.43), situation 4 (3.76-3.36 = 0.40) and the overall score (14.83-13.64 = 1.19) was obtained when the modified SPT was used instead of the original SPT (all with P < 0.001). Conclusion: The authors recommend replacing play items like spoon, knife, fork and plate with Oriental culture-based items like chopsticks and bowl for the modified SPT (Oriental version). Users of the test should have a set of toy train carts available to supplement the tractor and trailer as these toys were not commonly seen in real life for Oriental children. The authors hope that the modified SPT can be used reliably to assess for preverbal ability of Oriental children, especially Chinese children. © 2006 Blackwell Publishing Asia.link_to_subscribed_fulltex