EEG reactivity to pain in comatose patients: Importance of the stimulus type

IntroductionElectroencephalogram (EEG) background reactivity is a potentially interesting outcome predictor in comatose patients, especially after cardiac arrest, but recent studies report only fair interrater reliability. Furthermore, there are no definite guidelines for its testing. We therefore investigated the EEG effect of standardized noxious stimuli in comatose patients not reactive to auditory stimuli.MethodsIn this prospective study we applied a protocol using three different painful stimuli (bilateral nipple pinching, pinprick at the nose base, finger-nail compression on each side), grouped in three distinct clusters with an alternated sequence, during EEG recordings in comatose patients. We only analyzed recordings showing any reactivity to pain. Fisher and χ² tests were used as needed to assess contingency tables.ResultsOf 42 studies, 12 did not show any background reactivity, 2 presented SIRPIDs, and 2 had massive artefacts; we thus analyzed 26 EEGs recorded in 17 patients (4 women, 24%). Nipple pinching more frequently induced a change in EEG background activity (p < 0.001), with a sensitivity of 97.4% for reactivity. Neither the order of the stimuli in the cluster (p = 0.723), nor the cluster order (p = 0.901) influenced the results.ConclusionIn this pilot study, bilateral, synchronous nipple pinching seems to be the most efficient method to test nociceptive EEG reactivity in comatose patients. This approach may enhance interrater reliability, but deserves confirmation in larger cohorts.     

Effects of common FTO gene variants associated with BMI on dietary intake and physical activity in Koreans

BackgroundAssociations with FTO (fat mass and obesity associated) gene variants and BMI have been reported in western adult populations. To widen the ethnic and age coverage of the FTO studies, we investigated the effects of FTO gene variants on being overweight and related phenotypes in Korean children and adult with a consideration of lifestyle factors.MethodsWe genotyped 711 children for 2 FTO SNPs (rs9939973 and rs9939609), analyzed lifestyle factors, and investigated the potential involvement of FTO variants in being overweight comparing with 8842 adults in the KSNP database.ResultsWith a strong association between FTO gene variants and BMI levels, we further identified an association between rs9939973 or rs9939609 and being overweight both children (P = 0.025, OR = 1.47, 95% CI = 1.05–2.06; P = 0.023, OR = 1.53, 95% CI = 1.06–2.22) and adults (P = 0.018, OR = 1.10, 95% CI = 1.02–1.19; P = 0.001, OR = 1.16, 95% CI = 1.06–1.27). Significant association was observed between rs9939609 and dietary fat intake in children (P = 0.008) but not in adults. In low physical activity subgroup of children, rs9939609 A allele carriers had a higher BMI than TT carriers (P = 0.0147). A significant interaction effect of rs9939609 on BMI across 3 levels of adult physical activity was found.ConclusionsFTO variant rs9939609 is an overweight susceptibility gene in Koreans. By low physical activity, A allele greatly influenced greater BMI.     

Antinociceptive desensitizing actions of TRPV1 receptor agonists capsaicin,resiniferatoxin and N-oleoyldopamine as measured by determination of the noxious heat and cold thresholds in the rat

Agonists of the TRPV1 receptor excite TRPV1-expressing polymodal nociceptors that is followed after higher doses by a state of diminished responsiveness called desensitization which ensues at two levels: (i) diminished responsiveness of the ion channel (TRPV1 receptor desensitization); (ii) diminished responsiveness of the nerve endings to all stimuli including noxious heat. The aim was to compare these desensitizing actions of TRPV1 agonists in the rat by measuring with an incremental hot/cold plate the noxious heat and cold thresholds, i.e. the lowest hot and highest cold plate temperature, respectively, that evokes nocifensive behaviour. Capsaicin (3.3–1000 nmol) or resiniferatoxin (0.016–0.5 nmol) applied intraplantarly evoked a sustained dose-dependent elevation of the noxious heat threshold lasting for 2–11 days. N-oleoyldopamine failed to elevate the heat threshold. The noxious cold threshold was decreased by capsaicin or resiniferatoxin with a recovery within 2–4 days. The diminished acute nocifensive and heat threshold-lowering effects of resiniferatoxin or N-oleoyldopamine by pretreatment with doses that failed to elevate the heat threshold and to alter the nocifensive action of the TRPA1 activator formaldehyde, were taken as indication of TRPV1 receptor desensitization. In conclusion, using measurement of threshold temperatures eliciting nocifensive reactions in rats both in the hot and cold range revealed that capsaicin and RTX impair thermosensation in both noxious ranges due to a functional desensitization of peripheral terminals of TRPV1-expressing sensory neurons responsible for noxious heat and cold responsiveness. This could be differentiated from desensitization of TRPV1 receptor evoked by lower doses of resiniferatoxin or N-oleoyldopamine.     

Neuronal apoptosis may not contribute to the long-term cognitive dysfunction induced by a brief exposure to 2% sevoflurane in developing rats

BackgroundSevoflurane is an inhaled anesthetic commonly used in the pediatric. Recent animal studies suggest that early exposure to high concentration of sevoflurane for a long duration can induce neuroapoptosis and later cognitive dysfunction. However, the neurodevelopmental impact induced by lower concentration and shorter exposure duration of sevoflurane is unclear. To investigate whether early exposure to 2% concentration of sevoflurane for a short duration (clinically relevant usage of sevoflurane) can also induce neuroapoptosis and later cognitive dysfunction.MethodsRat pups were subjected to control group, 2% sevoflurane for 3 h and 3% sevoflurane for 6 h. TUNEL assay and apoptotic enzyme cleaved caspase-3 measured by western blot were used for detection of neuronal apoptosis in frontal cortex and CA1 region of hippocampus 24 after sevoflurane treatment. Long-term cognitive function was evaluated by Morris water maze and passive avoidance test as the rats grew up.ResultsThe apoptotic levels in frontal cortex and CA1 region were significantly increased after rats exposed to 3% sevoflurane for 6 h (P < 0.05), but not 2% sevoflurane for 3 h (P > 0.05). Exposure to both 2% sevoflurane for 3 h and 3% sevoflurane for 6 h could cause long-term cognitive dysfunction and animals exposed to 3% sevoflurane for 6 h exhibited worse neurodevelopmental outcomes (P < 0.05).ConclusionIt was suggested that neuronal apoptosis might not contribute to long-term cognitive dysfunction induced by 2% concentration and short exposure time of sevoflurane. Our findings also suggested that the mechanisms of sevoflurane-induced neurodevelopmental impact might be various, depending on the concentration and exposure duration.     

Identification of local angiogenic and inflammatory markers in the menstrual blood of women with endometriosis

The aim of this study was to evaluate the presence of myeloperoxidase (MPO), N-acetyl-β-D-glucosaminidase (NAG), tumor necrosis factor alpha (TNF-α) and vascular endothelial growth factor (VEGF) in peripheral and menstrual blood in women with (n = 10) and without (n = 7) endometriosis. NAG and MPO activities were evaluated by enzymatic methods, whereas TNF-α and VEGF by immunoassay. No significant differences were found for these markers, neither in menstrual nor in peripheral blood between groups. Menstrual blood NAG (P = 0.039) and MPO (P = 0.0117) activities in the endometriosis group were significantly higher than in peripheral blood. NAG and MPO presented positive linear correlation in peripheral (P = 0.07; r = 0.641) and menstrual blood (P = 0.01; r = 0.603). These findings point to the existence of an increased local inflammatory activity in women with endometriosis.     

Impacto de una intervención educacional sobre la calidad de la dieta mediterránea,la actividad física y el estado ponderal en adolescentes: ensayo clínico aleatorizado

ObjectiveTo analyse the impact of an educational intervention on the quality of the Mediterranean diet, physical activity and weight status in adolescents.MethodRandomised clinical trial (RCT), controlled with a multimodal educational intervention (control group [n = 36] and experimental group [n = 46]). Data collection at the beginning and end of the study, in teenagers from Cáceres, Spain. In both groups anthropometric measurements and sociodemographic data were determined. The quality of the Mediterranean diet was assessed through the KIDMED test, the degree of physical activity through the PAQ-A questionnaire and weight status with the growth charts of the Faustino Orbegozo Eizaguirre Foundation.ResultsWe obtained a significant increase in the experimental group in the PAQ-A questionnaire that assesses physical activity (P = .029). No significant differences were observed between groups in the weight status (P = .916). When comparing the quality of the Mediterranean diet (high vs moderate or low quality) with physical activity (P control = .730; experimental P = .495) and with weight status (P control = .838; experimental P = .372), No significant differences are observed.ConclusionsThe educational intervention did not improve the quality of the Mediterranean diet or physical activity, although most of our sample had normal weight and acceptable physical activity. We must continue to improve the healthy eating pattern of our adolescents, to ensure an adequate state of health in the future.     

Coordination between pelvis and shoulder girdle during walking in bilateral cerebral palsy

BackgroundStudies revealed that pelvis and shoulder girdle kinematics is impaired in children with the diplegic form of bilateral cerebral palsy while walking. The features of 3D coordination between these segments, however, have never been evaluated.MethodsThe gait analyses of 27 children with bilateral cerebral palsy (18 males; mean age 124 months) have been retrospectively reviewed from the database of a Movement Analysis Laboratory. The spatial–temporal parameters and the range-of-motions of the pelvis and of the shoulder girdle on the three planes of motion have been calculated. Continuous relative phase has been calculated for the 3D pelvis–shoulder girdle couplings on the transverse, sagittal and frontal planes of motion to determine coordination between these segments. Data from 10 typically developed children have been used for comparison.Findings: Children with bilateral cerebral palsy walk with lower velocity (P = 0.01), shorter steps (P < 0.0001), larger base of support (P < 0.01) and increased duration of the double support phase (P = 0.005) when compared to typically developed children. The mean continuous relative phase on the transverse plane has been found lower in the cerebral palsy group throughout the gait cycle (P = 0.003), as well as in terminal stance, pre-swing and mid-swing. The age, gait speed and pelvis range-of-motions on the transverse plane have been found correlated to continuous relative phase on the transverse plane.Interpretation: Compared with typically developed children, children with bilateral cerebral palsy show a more in-phase coordination between the pelvis and the shoulder girdle on the transverse plane while walking.     

Impact of Kinect-based virtual reality training on physical fitness and quality of life in severely burned children: A monocentric randomized controlled trial

Pediatric burns lead to persistent and detrimental muscle breakdown, weakness and poor quality of life, so rehabilitation is integral for improving physical and psychological outcomes. However, children with burns are a major challenge to a rehabilitation team. To overcome these challenges, enjoyable and interesting interventions are suggested. Objective: we aimed to determine the impact of the Xbox Kinect on cardiopulmonary fitness, muscle strength, lean mass, quality of life and enjoyment in severely burned children after hospital discharge. Methods: this was a randomized controlled trial in a single centre. Participants (n = 40 children) with burn injuries were randomized to the Xbox training group (n = 20) or control group (n = 20) during 12 weeks. All children received a home programme rehabilitation and Xbox training children received Xbox training. Outcomes included cardiopulmonary fitness (VO₂peak), muscle strength (peak torque), lean mass (whole-body and regional), quality of life and physical activity enjoyment at baseline, immediately after hospital discharge, and 12 weeks after the intervention. Results: the mean (SD) age of the 40 children was 12.97 (1.42) years and total body surface area of burn was 51% (5). The groups did not differ in characteristics at baseline (P > 0.05). After 12 weeks of the intervention, the groups significantly differed in VO₂peak, peak torque, quality of life (P < 0.001), lean mass and leg lean mass (P < 0.05) in favour of Xbox training. The mean difference in VO₂peak, peak torque, lean mass and leg lean mass was 3.25 (2.1; 4.5) ml/kg/min, 7.5 (5.8; 9.2) Nm, 1.81 (0.5; 3.1) kg, and 1.1 (0.1; 2.1) kg, respectively. Lean trunk mass did not significantly differ between groups (P = 0.07). The Xbox training group reported significantly more enjoyment than did the control group (P < 0.001). Conclusion: Xbox Kinect training can increase cardiopulmonary fitness, muscle strength, lean mass and quality of life in burned children. It is one of the most enjoyable, motivated and efficient treatment modalities that should be widely introduced into the pediatric burn rehabilitation. Trial registration. ClinicalTrials.gov (ID: NCT04350034).     

Expectations and positive emotional feelings accompany reductions in ongoing and evoked neuropathic pain following placebo interventions

Research on placebo analgesia and nocebo hyperalgesia has primarily included healthy subjects or acute pain patients, and it is unknown whether these effects can be obtained in ongoing pain in patients with chronic pain caused by an identifiable nerve injury. Eighteen patients with postthoracotomy neuropathic pain were exposed to placebo and nocebo manipulations, in which they received open and hidden administrations of pain-relieving (lidocaine) or pain-inducing (capsaicin) treatment controlled for the natural history of pain. Immediately after the open administration, patients rated their expected pain levels on a mechanical visual analogue scale (M-VAS). They also reported their emotional feelings via a quantitative/qualitative experiential method. Subsequently, patients rated their ongoing pain levels on the M-VAS and underwent quantitative sensory testing of evoked pain (brush, pinprick, area of hyperalgesia, wind-up-like pain). There was a significant placebo effect on both ongoing (P = .009 to .019) and evoked neuropathic pain (P = .0005 to .053). Expected pain levels accounted for significant amounts of the variance in ongoing (53.4%) and evoked pain (up to 34.5%) after the open lidocaine administration. Furthermore, patients reported high levels of positive and low levels of negative emotional feelings in the placebo condition compared with the nocebo condition (P ⩽ .001). Pain increases during nocebo were nonsignificant (P = .394 to 1.000). To our knowledge, this is the first study to demonstrate placebo effects in ongoing neuropathic pain. It provides further evidence for placebo-induced reduction in hyperalgesia and suggests that patients’ expectations coexist with emotional feelings about treatments.     

Increased serum levels of microvesicles in nonvalvular atrial fibrillation determinated by ELISA using a specific monoclonal antibody AD-1

BackgroundMicrovesicles are involved in different pathological processes such as inflammation, coagulation and tumor progression. We intended to establish an immunoaffinity capture method for detecting microvesicles and bioactive effectors carried on them using a specific homemade monoclonal antibody AD-1. By this method we investigated the association of inflammation with platelet activation in patients with nonvalvular atrial fibrillation (NVAF).MethodsA case–control study of 90 Chinese subjects selected in 3 groups: control, paroxysmal AF, and persistent AF. After capturing the microvesicles of serum using a specific monoclonal antibody AD-1, the amounts of LAP, IL-1β and P-selectin loaded on these microvesicles were quantified by either enzyme activity assay (LAP) or ELISA respectively.ResultsCompared with normal controls, the patients with persistent AF showed significantly increased serum levels of microvesicles (P < 0.001), microvesicle-bound IL-1 β (P = 0.019) and microvesicle-bound P-selectin (P = 0.001). The latter two were significantly correlated with each other (r² = 0.371, r = 0.616, P < 0.001). The microvesicle-bound IL-1β (β = 0.570, P < 0.001) and body weight (β = 0.427, P = 0.002) were as independent predictors of platelet activation.ConclusionsThe method was easy and reproducible. Inflammation may be involved in the activation of platelets in NVAF.     

Effect of a high-intensity interval training on serum microRNA levels in women with breast cancer undergoing hormone therapy. A single-blind randomized trial

BackgroundThe role of microRNAs (miRs) in hormone therapy (HT) is of keen interest in developing biomarkers and treatments for individuals with breast cancer. Although miRs are often moderate regulators under homeostatic conditions, their function is changed more in response to physical activity.ObjectiveThis single-blind randomized trial aimed to explore the effect of high-intensity interval training (HIIT) on serum levels of miRs in individuals with early-stage breast cancer undergoing HT.MethodsHormone receptor-positive women with breast cancer and healthy women were randomly assigned to a healthy control group (n = 15), healthy group with HIIT (n = 15), breast cancer group with HT (HT, n = 26), and breast cancer group with HT and HIIT (HT + HIIT, n = 26). The exercise groups underwent interval uphill walking training on a treadmill 3 times a week for 12 weeks. At the end of the study, we analyzed changes in levels of cancer-related miRs (oncomiRs) and tumour suppressor miRs (TSmiRs) in response to the HT and HIIT.ResultsIn women with breast cancer versus healthy controls, the expression of some oncomiRs was significantly increased — miR-21 (P < 0.001), miR-155 (P = 0.001), miR-221 (P = 0.008), miR-27a (P < 0.001), and miR-10b (P = 0.007) — and that of some TSmiRs was significantly decreased — miR-206 (P = 0.048), miR-145 (P = 0.011), miR-143 (P = 0.008), miR-9 (P = 0.020), and let-7a (P = 0.005). Moreover, HT considerably downregulated oncomiRs and upregulated TSmiRs. HIIT for 12 weeks with HT significantly decreased the expression of the oncomiRs and significantly increased that of the TSmiRs as compared with HT alone.ConclusionsHITT could amplify the decrease and/or increase in expression of miRs associated with HT in women with breast cancer. A prospective trial could determine whether the use of circulating miRs for monitoring treatment can be useful in therapy decisions.Trial registrationIranian Registry of Clinical Trials (No.: IRCT201202289171N1).     

Effects of V279F in the Lp-PLA2 gene on markers of oxidative stress and inflammation in Koreans

BackgroundA single nucleotide polymorphism (SNP), V279F, in the lipoprotein-associated phospholipase A₂ (Lp-PLA₂) gene is known to influence enzyme activity. It is unclear whether Lp-PLA₂ exerts pro- or antiatherogenic effects in humans. We investigated the interplay between V279F, Lp-PLA₂ activity, oxidative stress and inflammation.MethodsWe genotyped 2914 healthy Koreans (43–79 years) for the Lp-PLA₂ V279F and measured anthropometric parameters, lipid profile, fatty acid composition, lipid peroxides, inflammatory markers and Lp-PLA₂ levels.ResultsLp-PLA₂ activity was 24% lower in V/F subjects (n = 641) than in those with the V/V genotype (n = 2227). Enzyme activity was undetectable in F/F subjects. Lp-PLA₂ activity was positively correlated with LDL-cholesterol (r = 0.134, P < 0.001), ox-LDL (r = 0.064, P < 0.01), 8-epi-PGF_2α (r = 0.198, P < 0.001), free fatty acid (r = 0.082, P < 0.001), and fibrinogen (r = 0.112, P < 0.01) levels. Additionally, ox-LDL, 8-epi-PGF_2α, free fatty acid, and fibrinogen levels were positively correlated with hs-CRP. V279F was associated with LDL-cholesterol and arachidonic acid (AA) in serum phospholipid. F/F subjects had lower LDL-cholesterol than V/V subjects (V/V: 120.9 ± 0.69, V/F: 119.4 ± 1.26, F/F: 109.2 ± 4.84 mg/dl, P = 0.025). A significant association between the F/F genotype and increasing AA in serum phospholipids was found in subjects with high LDL-cholesterol (≥ 130 mg/dl) (P = 0.003) but not in those with low LDL-cholesterol (< 130 mg/dl). F/F subjects in the high LDL-cholesterol group had CRP concentrations about three times higher than those with V/V or V/F genotypes (V/V: 1.25 ± 0.09, V/F: 0.97 ± 0.12, F/F: 3.20 ± 0.88 mg/dl, P < 0.001).ConclusionsThe recessive effects of Lp-PLA₂ V279F on LDL-cholesterol and significant correlations between Lp-PLA₂ activity and LDL-cholesterol, 8-epi-PGF_2α and fibrinogen support a pro-oxidative or pro-atherogenic role for this enzyme. Paradoxically, the combination of the complete deficiency of Lp-PLA₂ activity and high LDL-cholesterol enhanced lipid peroxidation and inflammation.     

Parents' Experiences of Pediatric Palliative Care and the Impact on Long-Term Parental Grief

ContextApproximately 25% of children diagnosed with cancer eventually die. Losing a child puts parents at increased risk for developing psychological problems.ObjectivesTo explore parents' perceptions of the interaction with health care professionals (communication, continuity of care, and parental involvement) and symptom management during the pediatric palliative phase, and to investigate the influence on long-term grief in parents who lost a child to cancer.MethodsA total of 89 parents of 57 children who died of cancer between 2000 and 2004 participated in this retrospective cross-sectional study by completing a set of questionnaires measuring grief (Inventory of Traumatic Grief), parents' perceptions of the interaction with health care professionals (communication, continuity of care, and parental involvement), and symptom management during the palliative phase. Care was assessed on a five point Likert scale (1 = disagree and 5 = agree).ResultsParents highly rated communication (4.6 ± 0.6), continuity of care (4.3 ± 0.6), and parental involvement (4.6 ± 0.7) during the palliative phase. Parents' most often reported physical and psychological symptoms of their child during the palliative phase were fatigue (75%), pain (74%), anxiety to be alone (52%), and anger (48%). Higher ratings of parents on communication (β = −9.08, P = 0.03) and continuity of care (β = −11.74, P = 0.01) were associated with lower levels of long-term parental grief. The severity of the child's dyspnea (β = 2.96, P = 0.05), anxiety to be alone (β = 4.52, P < 0.01), anxiety about the future (β = 5.02, P < 0.01), anger (β = 4.90, P < 0.01), and uncontrolled pain (β = 6.60, P < 0.01) were associated with higher levels of long-term parental grief. Multivariate models combining the interaction with health care professionals and symptom management showed a significant influence of both aspects on long-term parental grief.ConclusionBoth interaction with health care professionals, especially communication and continuity of care, and symptom management in children dying of cancer are associated with long-term parental grief levels.     

Autoimmune hemolytic anemia (AIHA) following allogeneic hematopoietic stem cell transplantation (HSCT): A retrospective analysis and a proposal of treatment on behalf of the Grupo Español De Trasplante de Medula Osea en Niños (GETMON) and the Grupo Español de Trasplante Hematopoyetico (GETH)

Autoimmune hemolytic anemia (AIHA) is a complication of allogeneic hematopoietic stem cell transplantation (HSCT) associated with poor outcome. However, an optimal therapeutic approach is lacking.Between 2000 and 2015, 4099 allogeneic HSCT were performed in eight pediatric centers of the Grupo Español De Trasplante de Medula Osea en Niños (GETMON) and six adult centers of the Grupo Español de Trasplante Hematopoyetico (GETH). Sixty cases of AIHA were registered with a cumulative incidence of 1.5% occurring at a median of 6 months after HSCT. Patients aged less than 15 years (P = .005), and patients using cord blood (P = .005) or an HLA mismatch donor (P = .005) were more likely to develop AIHA. Most patients were lymphopenic at the time of diagnosis of AIHA, including a low number of regulatory T lymphocytes (median 3/μL).Median lines of treatment received for AIHA was 3 (range, 1-7). Almost all patients received corticosteroids (88%) and more than half received immunoglobulins or rituximab (63% and 67%, respectively). Complete resolution of AIHA was achieved in 33 of 60 cases (55%). Cumulative incidence of AIHA-related mortality was 17 ± 6%. We found a correlation of AIHA outcome with age (better outcome in younger than 15 years, RR = 1.87, P = .01) and rituximab response (higher rate of complete remission in patients responding to rituximab, RR = 1.72, P = .025). We analyzed the factors involved in the response to rituximab and found a better response when there was ABO donor/receptor disparity (P = .014) and in those patients with B lymphocytes count above the median (38/μL) (P = .05).Thirty-six of 60 patients survived yielding a disease free survival of 52±8% at 40 months. In Cox analysis, age (children vs adults, HR: 8.19, CI 95%: 2.39-28.12, P = .001) and AIHA outcome (complete remission vs partial remission/non-response, HR: 4.18, CI 95%: 1.55-11.22, P = .005) were associated with a better survival.Our data suggest that patients who developed AIHA after HSCT are severely lymphopenic and have a high risk of mortality. Outcome is better in children and in patients treated with rituximab. We also propose an algorithm for treatment of AIHA after HSCT.     

Effects of a nurse-led transitional care program on clinical outcomes,health-related knowledge,physical and mental health status among Chinese patients with coronary artery disease: A randomized controlled trial

BackgroundCoronary artery disease is a major cause of morbidity and mortality among adults worldwide, including China. After a hospital stay, transitional care could help to ensure improved patient care and outcomes, and reduce Medicare costs. Nevertheless, the results of the existing transitional care are not always satisfactory and our knowledge of how to perform effective transitional care for patients with coronary artery disease is limited in mainland China.ObjectivesTo examine the effectiveness of a nurse-led transitional care program on clinical outcomes, health-related knowledge, and physical and mental health status among Chinese patients with coronary artery disease.DesignRandomized controlled trial.MethodsThe Omaha system and Pender’s health promoting model were employed in planning and implementing this nurse-led transitional care program. The sample was comprised of 199 Chinese patients with coronary artery disease. The experimental group (n = 100) received nurse-led transitional care intervention in addition to routine care. The nurse-led transitional care intervention included a structured assessment and health education, followed by 7 months of individual teaching and coaching (home visits, telephone follow-up and group activity). The control group (n = 99) received a comparable length routine care and follow-up contacts. Evaluations were conducted at baseline and completion of the interventions using the perceived knowledge scale for coronary heart disease, the medical outcomes study 36-item short-form health survey and clinical measures (blood pressure, blood glucose, lipids, body mass index). Data were collected between March and October 2014.ResultsCompared with the control group, participants in the experimental group showed significant better clinical outcomes (systolic blood pressure, t = 5.762, P = 0.000; diastolic blood pressure, t = 4.250, P = 0.000; fasting blood glucose, t = 2.249, P = 0.027; total cholesterol, t = 4.362, P = 0.000; triglyceride, t = 3.147, P = 0.002; low density lipoprotein cholesterol, t = 2.399, P = 0.018; and body mass index, t = 3.166, P = 0.002), higher knowledge scores for coronary artery disease (total knowledge score, t = −7.099, P = 0.000), better physical health status (t = −2.503, P = 0.014) and mental health status (t = −2.950, P = 0.004).ConclusionsThis study provides evidence for the value of a nurse-led transitional care program using both the Omaha system and Pender’s health promoting model as its theoretical framework. The structured interventions in this nurse-led transitional care program facilitate the use of this program in other settings.     

Long-term depression of spinal nociception and pain in man: Influence of varying stimulation parameters

Electrical low-frequency stimulation (LFS) of spinal afferents induces long-term depression (LTD) of nociceptive processing in rodents. LTD and its parameters in man are largely unknown. This study addresses the hypothesis that LTD of spinal nociception and pain in man depends on LFS frequency (0.5, 1, 2 Hz), number of electrical pulses (300, 600, 1200), intensity (relating to pain threshold I_P: 1 × I_P, 2 × I_P, 4 × I_P), and on LFS repetition. One hundred and twenty electrophysiological and psychophysical experiments were performed in 29 healthy volunteers. Painful electrical test stimulation (0.125 Hz) and conditioning LFS were applied to right hand dorsum by a concentric electrode. Somatosensory evoked cortical potentials (SEP) were recorded and volunteers rated stimulus intensity. LFS with 0.5, 1, and 2 Hz induced significant reduction of SEP and pain ratings as compared to Control group. Effect on SEP amplitude after 1 Hz LFS preponderated that of 2 Hz stimulation. LTD of SEP and pain perception was induced by noxious LFS with 300–1200 pulses. SEP suppression augmented with increasing number of pulses. LFS with intensities 2 × I_P and 4 × I_P evoked sustained depression of SEP and pain perception in comparison to Control and 1 × I_P LFS. Established LTD after single LFS was amplified by an additional second LFS. Hence this study provides electrophysiological and psychophysical evidence for LTD of spinal nociceptive processing and pain perception in man and indicates appropriate LFS parameters 1 Hz, 1200 pulses and 4 × I_P for future studies on human LTD.     

FTO and MC4R gene variants determine BMI changes in children after intensive lifestyle intervention

ObjectivesThis study aimed to determine whether there is a relationship between common FTO (rs17817449) and MC4R (rs17782313) gene variants and body mass reduction or weight loss after a one-month lifestyle intervention in overweight/obese children.Design and methodsWe genotyped 357 unrelated non-diabetic Czech children (age 13.7 ± 4.9 years, average BMI at baseline 30.8 ± 4.6 kg/m²). Biochemical and anthropometrical measurements were performed before and after 4 weeks of lifestyle interventions (comprising a reduction in energy intake to the age-matched optimum and a supervised exercise program consisting of 5 exercise units per day, 50 min each).ResultsThe mean weight loss achieved was 6.2 ± 2.1 kg (P < 0.001). Significant associations were found between a BMI decrease and the FTO and MC4R variants. Carriers of the FTO GG genotype and/or MC4R CC genotype lost significantly more body weight compared to noncarriers (P < 0.0009 for BMI and P < 0.002 for body weight). These differences remained significant following adjustment for sex, age and baseline values (P = 0.004 for BMI and P = 0.01 for body weight).ConclusionsFTO and MC4R gene variants modify the impact of an intensive lifestyle intervention on BMI decrease in overweight/obese children. Carriers of the FTO GG genotype and MC4R CC genotype benefit significantly more from the lifestyle intervention.     

Effects of a Full-Body Massage on Pain Intensity,Anxiety, and Physiological Relaxation in Taiwanese Patients with Metastatic Bone Pain: A Pilot Study

Bone involvement, a hallmark of advanced cancer, results in intolerable pain, substantial morbidity, and impaired quality of life in 34%–45% of cancer patients. Despite the publication of 15 studies on massage therapy (MT) in cancer patients, little is known about the longitudinal effects of MT and safety in cancer patients with bone metastasis. The purpose of this study was to describe the feasibility of MT and to examine the effects of MT on present pain intensity (PPI), anxiety, and physiological relaxation over a 16- to 18-hour period in 30 Taiwanese cancer patients with bone metastases. A quasi-experimental, one-group, pretest-post-test design with repeated measures was used to examine the time effects of MT using single-item scales for pain (PPI-visual analog scale [VAS]) and anxiety (anxiety-VAS), the modified Short-Form McGill Pain Questionnaire (MSF-MPQ), heart rate (HR), and mean arterial pressure (MAP). MT was shown to have effective immediate [t(29) = 16.5, P = 0.000; t(29) = 8.9, P = 0.000], short-term (20–30 minutes) [t(29) = 9.3, P = 0.000; t(29) = 10.1, P = 0.000], intermediate (1–2.5 hours) [t(29) = 7.9, P = 0.000; t(29) = 8.9, P = 0.000], and long-term benefits (16–18 hours) [t(29) = 4.0, P = 0.000; t(29) = 5.7, P = 0.000] on PPI and anxiety. The most significant impact occurred 15 [F = 11.5(1,29), P < 0.002] or 20 [F = 20.4(1,29), P < 0.000] minutes after the intervention. There were no significant time effects in decreasing or increasing HR and MAP. No patient reported any adverse effects as a result of MT. Clinically, the time effects of MT can assist health care providers in implementing MT along with pharmacological treatment, thereby enhancing cancer pain management. Randomized clinical trials are needed to validate the effectiveness of MT in this cancer population.