Can People with Chronic Neck Pain Recognize Their Own Digital Pain Drawing?

Background: Although the reliability of pain drawings (PDs) has been confirmed in people with chronic pain, there is a lack of evidence about the validity of the PD, that is, does the PD accurately represent the pain experience of the patient? Objectives: We investigate whether people with chronic neck pain (CNP) can recognize their own PD to support the validity of the PD in reporting the experience of pain. Moreover, we examined the association between their ability to recognize their own PD with their levels of pain intensity and disability and extent of psychosocial and somatic features. Study Design: Experimental. Setting: University Laboratory. Methods: Individuals with CNP completed their PD on a digital body chart, which was then automatically modified with specific dimensions using a novel software, providing an objective range of distortion and eliminating errors, which could potentially occur in manually controlled visual-subjective based methods. Following a 10-minute break listening to music, a series of 20 PDs were presented to each patient in a random order, with only 2 being their original PD. For each PD, the patients rated its likeliness to their own original PD on a scale from 0 to 100, with 100 representing “this is my pain.” Results: Overall, the patients rated their original PD with a median score of 92% similarity, followed by 91.8% and 89.5% similarity when presented with a PD scaled down to 75% and scaled up by 150% of the original size, respectively; these scores were not significantly different to the ratings given for their original PD. The PD with horizontal translation by 40 pixels (8%) and vertical translation by 70 pixels (12.8%) were rated as the most dissimilar to their original PD; these scores were significantly different to their original PD scores. The Spearman correlation coefficient revealed a significant negative association between their ability to recognize their original PD and their Modified Somatic Perceptions Questionnaire scores. Limitations: The patients in the study presented with relatively mild CNP, and the results may not be generalized to those with more severe symptoms. Conclusions: People with CNP are generally able to identify their own PD but that their ability to recognize their original PD is negatively correlated with the extent of somatic awareness

Liver Transplantation in Patients with Portal Vein Thrombosis: Revisiting Outcomes According to Surgical Techniques

Surgical strategies for graft portal vein flow restoration vary from termino-terminal portal vein anastomosis to more complex bypass reconstructions. Although the surgical strategy strongly influences the post-operative outcome, the Yerdel grading is still commonly used to determine the prognosis of patients with portal vein thrombosis (PVT) undergoing liver transplantation (LT). We retrospectively reviewed the cases of LT performed on recipients with complex PVT at two high-volume transplantation centres. We stratified the patients by the type of portal vein reconstruction, termino-terminal portal vein anastomosis (TTA) versus bypass reconstruction (bypass group), and assessed a multivariable survival analysis. The rate of mortality at 90 days was 21.4% for the bypass group compared to 9.8% in the TTA group (p = 0.05). In the multivariable correlation analysis, only a trend for greater risk of early mortality was confirmed in the bypass groups (HR 2.5; p = 0.059). Yerdel grade was uninfluential in the rate of early complications. A wide range of surgical options are available for different situations of PVT which yield an outcome unrelated to the Yerdel grading. An algorithm for PVT management should be based on the technical approach and should include a surgically oriented definition of PVT extension

Two-stage hepatectomy with radioembolization for bilateral colorectal liver metastases: A case report

BACKGROUND Two-stage hepatectomy (TSH) is a well-established surgical technique, used to treat bilateral colorectal liver metastases (CRLM) with a small future liver remnant (FLR). However, in classical TSH, drop-out is reported to be around 25%- 40%, due to insufficient FLR increase or progression of disease. Trans-arterial radioembolization (TARE) has been described to control locally tumor growth of liver malignancies such as hepatocellular carcinoma, but it has been also reported to induce a certain degree of contralateral liver hypertrophy, even if at a lower rate compared to portal vein embolization or ligation. CASE SUMMARY Herein we report the case of a 75-year-old female patient, where TSH and TARE were combined to treat bilateral CRLM. According to computed tomography (CT)-scan, the patient had a hepatic lesion in segment VI-VII and two other confluent lesions in segment II-III. Therefore, one-stage posterior right sectionectomy plus left lateral sectionectomy (LLS) was planned. The liver volumetry estimated a FLR of 38% (segments I-IV-V-VIII). However, due to a more than initially planned, extended right resection, simultaneous LLS was not performed and the patient underwent selective TARE to segments II-III after the first surgery. The CT-scan performed after TARE showed a reduction of the treated lesion and a FLR increase of 55%. Carcinoembryonic antigen and CA 19.9 decreased significantly. Nearly three months later after the first surgery, LLS was performed and the patient was discharged without any postoperative complications. CONCLUSION According to this specific experience, TARE was used to induce liver hypertrophy and simultaneously control cancer progression in TSH settings for bilateral CRLM

Effects of 12 Weeks of Essential Amino Acids (EAA)-Based Multi-Ingredient Nutritional Supplementation on Muscle Mass, Muscle Strength, Muscle Power and Fatigue in Healthy Elderly Subjects: A Randomized Controlled Double-Blind Study

Objective: To counteract muscle mass, muscle strength and power loss during aging, and to study age-related change of neuromuscular manifestation of fatigue in relation to nutritional supplementation. Design: randomized controlled double-blind study. Setting: Twice-daily consumption for 12 weeks of an Essential Amino Acids (EAA)-based multi-ingredient nutritional supplement containing EAA, creatine, vitamin D and Muscle Restore Complex®. Participants: 38 healthy elderly subjects (8 male, 30 female; age: 68.91±4.60 years; body weight: 69.40±15.58 kg; height: 1.60±0.09 m) were randomized and allocated in supplement (SUPP) or placebo (PLA) group. Mean Measurements: Vitamin D blood level; Appendicular Lean Mass (ALM); Visceral Adipose Tissue (VAT); Maximal Voluntary Contraction (MVC) and Peak Power (PP); myoelectric descriptors of fatigue: Fractal Dimension and Conduction Velocity initial values (FD iv, CV iv), their rates of change (FD slopes, CV slopes) and the Time to perform the Task (TtT). Mean Results: Significant changes were found in SUPP compared to baseline: Vitamin D (+8.73 ng/ml; p<0.001); ALM (+0.34 kg; p<0.001); VAT (-76.25 g; p<0.001); MVC (+0.52 kg; p<0.001); PP (+4.82 W; p<0.001). Between group analysis (SUPP Vs. PLA) showed improvements: vitamin D blood levels (+11,72 ng/ml; p<0.001); Legs FFM (+443.7 g; p<0.05); ALM (+0.53 kg; p<0.05); MVC (+1.38 kg; p<0.05); PP (+9.87 W; p<0.05). No statistical changes were found for FD iv, CV iv, FD and CV slopes and TtT, either compared to baseline or between groups. Significant correlations between mean differences in SUPP group were also found. Conclusion: The study demonstrates that in healthy elderly subjects an EAA-based multi-ingredient nutritional supplementation of 12 weeks is not effective to change myoelectric manifestation of fatigue and TtT failure but can positively affect muscle mass, muscle strength, muscle power and VAT, counterbalancing more than one year of age-related loss of muscle mass and strength

Aldo-keto reductases are biomarkers of NRF2 activity and are co-ordinately overexpressed in non-small cell lung cancer

BACKGROUND: Although the nuclear factor-erythroid 2-related factor 2 (NRF2) pathway is one of the most frequently dysregulated in cancer, it is not clear whether mutational status is a good predictor of NRF2 activity. Here we utilise four members of the aldo-keto reductase (AKR) superfamily as biomarkers to address this question. METHODS: Twenty-three cell lines of diverse origin and NRF2-pathway mutational status were used to determine the relationship between AKR expression and NRF2 activity. AKR expression was evaluated in lung cancer biopsies and Cancer Genome Atlas (TCGA) and Oncomine data sets. RESULTS: AKRs were expressed at a high basal level in cell lines carrying mutations in the NRF2 pathway. In non-mutant cell lines, co-ordinate induction of AKRs was consistently observed following activation of NRF2. Immunohistochemical analysis of lung tumour biopsies and interrogation of TCGA data revealed that AKRs are enriched in both squamous cell carcinomas (SCCs) and adenocarcinomas that contain somatic alterations in the NRF2 pathway but, in the case of SCC, AKRs were also enriched in most other tumours. CONCLUSIONS: An AKR biomarker panel can be used to determine NRF2 status in tumours. Hyperactivation of the NRF2 pathway is far more prevalent in lung SCC than previously predicted by genomic analyses

Families_Share: digital and social innovation for work–life balance

Purpose: The European H2020 Families_Share project aims at offering a grass-root approach and a co-designed platform supporting families for sharing time and tasks related to childcare, parenting, after-school and leisure activities and other household tasks. To achieve this objective, the Families_Share project has been built on current practices which are already leveraging on mutual help and support among families, such as Time Banks, Social Streets and self-organizing networks of parents active at the neighbourhood level and seek to harness the potential of ICT networks and mobile technologies to increase the effectiveness of participatory innovation. The aim of this paper is to present and discuss the Families_Share methodology and platform, as well as the results obtained by several partecipating communities in different European countries. Design/methodology/approach: This paper discusses how the Families Share approach (CAPS project, Horizon 2020) is bringing the sharing economy to childcare. Families Share developed a co-caring approach and a co-designed digital welfare platform to support parents with sharing time and tasks related to childcare, after-school and leisure activities. Families Share conducted two iterative pilot experiments and related socio-economic evaluations in six European cities. More than 3,000 citizens were engaged in the co-design process through their local community organizations and more than 1,700 parents and children actively experimented with the approach by organizing collaborative childcare activities. The authors discuss the challenges and solutions of co-designing a socio-technical approach aimed at facilitating socially innovative childcare models, and how the Families Share approach, based on technology-supported co-production of childcare, may provide a new sustainable welfare model for municipalities and companies with respect to life––work balance. Findings: The authors discuss the challenges and solutions of co-designing a technological tool aimed at facilitating socially innovative childcare models, and how the Families Share approach may provide a new sustainable welfare model for municipalities and companies with respect to work–life balance. Originality/value: As a main difference with state-of-the-art proposals, Families_Share is aimed to provide support to networks of parents in the organization of self-managed activities, this way being orthogonal with respect either to social-network functionalities or to supply and demand services. Furthermore, Families_Share has been based on a participative approach for both the ICT platform and the overall structure

Transcranial Doppler Ultrasound and Transesophageal Echocardiography for Intraoperative Diagnosis and Monitoring of Patent Foramen Ovale in Non-Cardiac Surgery

Background: Patent foramen ovale (PFO) has been investigated in several conditions apart from cryptogenic ischemic stroke. Contrast transesophageal echocardiography (cTEE) is the gold standard for the diagnosis, although it has some known limitations. Contrast transcranial Doppler (cTCD) allows a semiquantitative estimation of right-to&#x2;left shunt (RLS) volume. The aims of our study were to confirm the diagnostic accuracy of cTCD in PFO diagnosis and to compare the abilities of cTCD and cTEE to detect a RLS and PFO, respectively, under normal breathing. The latter could represent an im&#x2;portant feature for its clinical significance.Methods: A total of 100 consecutive patients (59 women and 41 men, age 46 6 12 years) were evaluated after stabilized ischemic stroke/transient ischemic attack, migraine, and lacunae, and before neurosurgery in sitting position. All patients undertook cTEE and cTCD, at rest and under Valsalva maneuver (VM). cTEE under VM was the reference standard. A categorization of pa&#x2;tients and a semiquantitative cTCD classification were proposed. Results: In all, 63 of 100 patients had PFO diagnosed by cTEE. A general concordance of up to 90% be&#x2;tween both techniques was found. cTCD sensitivity and specificity were 96.8% and 78.4%, respectively. In 17 of 100 patients with cTEE-proven PFO under VM, cTCD and cTEE detected RLS at rest in 75% (95% confidence interval [CI] 62%-85%) and 48% (95% CI 35%-61%) of cases, respectively (P , .001). cTEE disclosed RLS at rest in about 71% (95% CI 9%-42%) of cTCDs showing a ‘‘shower-curtain’’ pattern and only in about 22% (95% CI 52%-85%) of those cTCDs without that pattern. Conclu&#x2;sions: In diagnosing PFO, cTCD has a good accuracy compared with cTEE. To detect a RLS at rest, cTCD appears to be more sensitive than cTEE. The latter resulted posi&#x2;tive under normal breathing, mostly in cases of significant RLS at cTCD. Our results point out the impact of cTCD in the evaluation of RLS volume, thus aiding, in associ&#x2;ation with the anatomic details by cTEE, in the prevention of the occurrence or recur&#x2;rence of paradoxical embolism in individuals with and without cerebrovascular diseases. The combination of cTEE and cTCD could be considered the real gold stan&#x2;dard for PFO in the near future. Key Words: Transcranial Doppler—transesophageal echocardiography—patent foramen ovale—stroke—right-to-left shun