The H-Wave® device is an effective and safe non-pharmacological analgesic for chronic pain: a meta-analysis

INTRODUCTION: This meta-analysis was conducted to systematically review the efficacy and safety of the H-Wave(R) (Electronic Waveform Lab, Inc, Huntington Beach, CA, USA) device and programme as a non-pharmacological analgesic treatment in chronic soft tissue inflammation and neuropathic pain. METHODS: Five studies related to pain relief, reduction in pain medication and increased functionality obtained with the H-Wave device were included in the analysis. Data were analysed using the random effects model, including adjustment to evaluate variability, size of study and bias in effect size. A total of 6535 participants were included in the meta-analysis; there were 8065 participants' outcomes measured due to multiple measurements per participant. RESULTS: The H-Wave device decreased pain ratings across various chronic soft tissue inflammation and neuropathic pain conditions. The mean weighted effect size was 0.59, and the estimated effect size variance was 0.00003 (95% confidence intervals [CI]: 0.580, 0.600). The H-Wave device also decreased the intake of pain medication in patients with various chronic soft tissue inflammation and neuropathic pain conditions. The mean weighted effect size was 0.56, and the estimated effect size variance was 0.000013 (95% CI: 0.553, 0.567). Patient functionality was also improved with use of the H-Wave device. The mean weighted effect size was 0.70, and the estimated effect size variance was 0.00002 (95% CI: 0.691, 0.709). A chi-square test for homogeneous effect sizes found highly significant (P<0.00001) variability, indicating a robust significant effect size for increased functionality relative to both pain relief and reduction in pain medication. There was little to no evidence of any adverse effects associated with the use of the H-Wave device. CONCLUSION: The findings indicate a moderate to strong effect of the H-Wave device in providing pain relief, reducing the requirement for pain medication and increasing functionality. The most robust effect was observed for improved functionality, suggesting that the H-Wave device may facilitate a quicker return to work and other related daily activities.     

An in vitro approach for demonstrating the critical role of serum albumin in the detoxication of the carbamate carbaryl at in vivo toxicologically relevant concentrations

The hydrolysis of carbaryl by bovine serum albumin (BSA) was studied at toxicologically relevant concentrations (range 15–300 μM) in order to determine the role of this protein in the detoxication of the carbamate in vivo. The 1-naphthol released during the hydrolysis of carbaryl was monitored using gas chromatography coupled with mass spectrometry. BSA hydrolyzed carbaryl in a time-progressive way. The hydrolysis was also dependent of enzyme (1.0, 2.5, 5.0 and 7.0 mg ml⁻¹) and substrate (range between 15 and 1,000 μM) concentration. The estimated turnover number and Michaelis–Menten constant were 1.6 × 10⁻⁴ s⁻¹ and 430 μM, respectively. Thus, the second order rate constant was 0.37 M⁻¹ s⁻¹. At enzyme concentrations of 7.0 mg ml⁻¹ and substrate concentrations ranging between 50 and 300 μM about 80% of substrate was hydrolyzed in 3 h. At lower substrate concentrations (15 and 30 μM carbaryl) also significant hydrolysis was detected at the highest enzyme concentration, even when these substrate concentrations were 30 and 15 times lower than the Michaelis–Menten constant. Although the efficacy of the enzymatic hydrolysis is low, the extrapolation of our results to the physiological albumin high concentrations (around 40 mg ml⁻¹) suggests that the hydrolysis of carbaryl by serum albumins plays a critical role in the detoxication of this carbamate at in vivo toxicologically relevant concentrations. Electronic supplementary material Supplementary material is available in the online version of this article at and is accessible for authorized users.     

Plasma phenylacetate and 1-naphthyl acetate hydrolyzing activities of wild birds as possible non-invasive biomarkers of exposure to organophosphorus and carbamate insecticides

Organophosphorus and carbamate insecticides inhibit the carboxylesterases found in plasma. Therefore, these carboxylesterases might be used as biomarkers of exposure to these insecticides. This work initiates the characterization of the phenylacetate (PA) and 1-nafthylacetate (NA) hydrolyzing activities (PAase and NAase) in the plasma of 11 different wild bird species and aims to determine their suitability as biomarkers of exposure. PAase activity values, expressed as mumol product/30min/mL plasma, ranged between 38+/-2.3 (black vulture) and 27+/-0.85 (barn owl), while NAase values ranged between 6.0+/-5.2 (griffon vulture) and 38+/-0.85 (barn owl). In all assayed species, NAase was between 1.1 and 2.8 times higher than the corresponding PAase. PAase and NAase of chicken white stork were 1.6 and 1.7 times higher, respectively, than the corresponding activities of adult individuals. Nocturnal raptors, eagle owl and barn owl, exhibited PAase and NAase between 1.3 and 8.0 times higher than activities exhibited by diurnal raptors (Montagu's harrier, common buzzard, booted eagle, Spanish imperial eagle, black kite, griffon vulture and black vulture). Data presented in this work suggest that plasma PAase and NAase of the studied birds might be used as biomarkers of exposure to organophosphorus and carbamate insecticides, although further studies of inhibition of these activities are still needed.     

Synovial chondromatosis of the temporomandibular joint: CT and MRI findings

We report a rare case of synovial chondromatosis of the temporomandibular joint (TMJ) in a 31-year-old man. CT examination showed a mixed soft tissue mass with small calcifications near the right TMJ joint space. MR images revealed a heterogeneous mass on the different sequences and, after contrast administration, originating in the right TMJ. Cytology showed chondroid cellularity. The lesion was surgically removed and final histological study demonstrated the diagnosis of a synovial chondromatosis. We highlight the importance of the complementary findings from CT and MR, especially the important specific feature described for TMJ synovial chondromatosis related to the mixed density within the mass, in order to perform an accurate preoperative diagnosis whenever there is an absence of ossified loose bodies.     

Low urinary 6-sulphatoxymelatonin concentrations in acute migraine

Substantial evidence points to melatonin as playing a role in the regulation of circadian rhythms, sleep, and headache disorders. The objective of the study was to assess 6-sulphatoxymelatonin (aMT6s) levels in a large consecutive series of patients with migraine, comparing with controls. A total of 220 subjects were evaluated-146 had migraine and 74 were control subjects. Urinary samples were collected into the same plastic container since 8:00 p.m. to 8:00 a.m. of the next day (12-h period) and aMT6s was measured with quantitative ELISA technique. Among patients with migraine, 53% presented pain on the day of the urine samples collection. Their urinary aMT6s concentration was significantly lower than in the urine of patients without pain [14.0 +/- 7.3 vs. 49.4 +/- 19.0; t(143) = -15.1; 95% CI = -40.0 to -30.8; P < 0.001]. There was no significant difference in the aMT6s concentration of patients with migraine without pain on the day of their urine samples collection and controls [49.4 +/- 19.0 vs. 42.5 +/- 27.9; t(140) = 1.7; 95% CI = -1.2 to 14.8; P = 0.094]. To our knowledge, this is the first study to demonstrate reduction in melatonin levels during attacks in episodic and chronic migraine.     

A spline-based non-linear diffeomorphism for multimodal prostate registration

This paper presents a novel method for non-rigid registration of transrectal ultrasound and magnetic resonance prostate images based on a non-linear regularized framework of point correspondences obtained from a statistical measure of shape-contexts. The segmented prostate shapes are represented by shape-contexts and the Bhattacharyya distance between the shape representations is used to find the point correspondences between the 2D fixed and moving images. The registration method involves parametric estimation of the non-linear diffeomorphism between the multimodal images and has its basis in solving a set of non-linear equations of thin-plate splines. The solution is obtained as the least-squares solution of an over-determined system of non-linear equations constructed by integrating a set of non-linear functions over the fixed and moving images. However, this may not result in clinically acceptable transformations of the anatomical targets. Therefore, the regularized bending energy of the thin-plate splines along with the localization error of established correspondences should be included in the system of equations. The registration accuracies of the proposed method are evaluated in 20 pairs of prostate mid-gland ultrasound and magnetic resonance images. The results obtained in terms of Dice similarity coefficient show an average of 0.980±0.004, average 95% Hausdorff distance of 1.63±0.48mm and mean target registration and target localization errors of 1.60±1.17mm and 0.15±0.12mm respectively.     

Hemoglobin Ohio (beta 142 Ala replaced by): a new abnormal hemoglobin with high oxygen affinity and erythrocytosis

Hemoglobin Ohio [beta 142 (H20) Ala replaced by Asp] was found in three members of a white family, all of whom showed erythrocytosis. The variant hemoglobin has a high oxygen affinity, a reduced Bohr effect, and diminished cooperativity. The functional abnormalities of Hb Ohio are explained by the proximity of the substituent beta 142 residue, both to beta 143 His, which is involved in the DPG binding site of hemoglobin, and to the critical C terminal region of the beta chain, which participates in the stabilization of the deoxy (T) conformation.