Modulation of intracortical inhibition in response to acute psychosocial stress is impaired among individuals with chronic neck pain

Objective

Psychosocial stress has been associated with a variety of chronic pain disorders although the mechanisms responsible for this relationship are unknown. The purpose of this study was to compare the excitability of intracortical and corticospinal pathways to the trapezius muscle in individuals with and without chronic neck pain during exposure to low and high levels of psychosocial stress.

Methods

Single and paired-pulse transcranial magnetic stimulation was used to assess motor evoked potentials (MEPs) and short-interval intracortical inhibition (SICI) during mental math performed in the presence and absence of social evaluative threat.

Results

All participants demonstrated higher amplitude MEPs in the high stress compared to the low stress condition (p < 0.01). Participants with chronic neck pain had significantly greater SICI than healthy participants in the low stress condition (p = 0.03). During exposure to the stressor, healthy participants showed an increase in SICI, whereas participants with neck pain showed no change (group difference for change in SICI, p < 0.01).

Conclusions

These findings suggest that individuals with chronic neck pain inhibit motor output to the trapezius in the presence of minor stressors, and are unable to compensate for additional stress-evoked increases in corticospinal excitability through further modulation of SICI. This observation has potential implications for the management of patients who have difficulty relaxing painful muscles during times of stress.     

Human papillomavirus and oral disease – emerging evidence: a review

Human papillomavirus (HPV) infections have received considerable attention in recent years. Of the 120 or so known types of the virus, some cause a variety of benign wart‐like lesions of the skin and genital and oral mucosae, whilst others are aetiologically associated with cervical and anogenital cancers. Recent epidemiologic evidence suggests that HPV may also be an independent risk factor for oropharyngeal cancer. In this context it has been suggested that HPV virus may modulate the process of carcinogenesis in some tobacco and alcohol induced oropharyngeal cancers and act as the primary oncogenic agent for inducing carcinogenesis among non‐smokers. Dental practitioners have a major role in detecting all lesions of the oral mucosa caused, or possibly caused, by HPV. This paper briefly reviews the current state of knowledge of molecular and clinical aspects of HPV infections of the oral mucosa.     

Platelet-derived growth factor in vivo: levels, activity, and rate of clearance

Platelet-derived growth factor (PDGF) is a potent mitogen for many cultured connective tissue cells. It is present in concentrated form within the platelet alpha-granules and is believed to be released during platelet degranulation at sites of vascular injury. We have used a sensitive radioreceptor assay to measure PDGF levels in whole blood serum from normal humans [17.5 +/- 3.1 (SD) ng/mL] and baboons (2.7 +/- 1.2 ng/mL). PDGF was not detected in plasma from either species. In addition, plasma was found to substantially reduce the ability of added purified PDGF to bind to the cell surface PDGF receptor on cultured cells, suggesting that plasma may contain a PDGF-binding protein that would serve to inactivate PDGF released into plasma. Calculations of PDGF concentrations in serum have been corrected for the effects of the binding protein. 125I-PDGF injected intravenously into normal baboons was cleared rapidly from the plasma (t1/2 = two minutes). The rapid clearance of 125I-PDGF did not result from iodination damage, as purified unlabeled PDGF was cleared with comparable kinetics. The rapid clearance of purified and iodinated PDGF did not result from changes in PDGF structure during purification or from removal of PDGF-associated proteins during purification, as PDGF present in freeze-thaw lysates of fresh platelets was cleared equally rapidly. We conclude that release of PDGF at sites of vascular injury would greatly increase the local concentration of PDGF and that PDGF not localized to the site of injury would be rapidly cleared from the circulation.     

Strength properties of soldered joints for a gold-palladium alloy and a palladium alloy

Strength of a soldered palladium alloy, PGC (Engelhard Corp.), and a soldered medium gold alloy, PGX (Engelhard Corp.), was examined. The results obtained were as follows: Highest strength was observed with postsoldered specimens of PGC alloy. Microstructural examination of postsoldered specimens revealed nearly pore-free solder joints with PGC and PGX alloys, and fracture appeared at the solder-alloy interface with PGC and PGX alloys. Microstructural examination of presoldered and presoldered/thermocycled specimens revealed that presoldered specimens of PGC and PGX alloys exhibited intrasolder fracture; PGX solder joints had considerably less porosity, which may explain the equivalent bond strengths of all the soldered specimens and the yield point of the controls; PGC solder joints exhibited large quantities of pores, which may explain the lower strength; pores observed in PGC alloy may be the result of the high fusing temperature of the solder; and these results indicate a need to develop a new presolder for PGC. The best result was obtained with postsoldered specimens of the PGC alloy. However, for PGX alloy, either postsolder or presolder techniques can be used.     

Gram stains have limited application in the diagnosis of infected total knee arthroplasty

Background

The diagnosis of periprosthetic knee infections can present a challenge to surgeons, especially in the case of chronic presentation. Gram stains are regularly performed as part of the microbiological evaluation of suspected infected total knee arthroplasties. Recently, the utility of this test in diagnosing infections has been questioned. The purpose of this study was to assess the effectiveness of Gram stains performed from surgical site samples by comparing their results to the final diagnosis of infection.

Methods

The results of 347 Gram stains performed at a single center at the time of revision total knee arthroplasty for both septic and aseptic reasons were compared to the final diagnosis based on intra-operative findings and histological evaluation.

Results

Gram staining demonstrated a low sensitivity of 7% (95% confidence interval 4–12%), a specificity of 99% (95% confidence interval 97–100%), and positive and negative predictive values of 92% and 57%, respectively.

Conclusions

This study confirmed previous findings of the poor utility of this test for the diagnosis of periprosthetic knee infections. The authors recommend that Gram staining no longer be performed at the time of suspected periprosthetic knee arthroplasty infection.     

Early failure of a unicompartmental knee arthroplasty design with an all-polyethylene tibial component

Refined prosthetic designs and surgical techniques for unicompartmental knee arthroplasty have recently been associated with improved outcomes. The purpose of the present study was to evaluate the clinical and radiographic outcomes of the EIUS unicompartmental design, which has an all-polyethylene tibial component, and to compare these outcomes with published reports of other unicompartmental prostheses. Between February 2002 and March 2005, 113 patients (144 knees) underwent a medial unicompartmental knee arthroplasty, all performed by a single surgeon who used the EIUS prosthesis. At a mean follow-up of 36 months (range, 24–54 months), the mean Knee Society objective and functional scores improved from 55 points (range, 31–77 points) and 49 points (range, 35–60 points) to 92 points (range, 45–100 points) and 89 points (range, 10–100 points), respectively. The implant survival rate was 89%, with 16 knees either revised or scheduled for revision. The reasons for revision included aseptic loosening of the tibial component (eight knees), progressive symptomatic patellofemoral disease (four knees), and tibial component subsidence (four knees). Multiple regression analysis revealed that age, gender, and body mass index were not significantly correlated with success or failure of this design, although nine of the 16 patients who required revision were obese. This prosthesis was associated with higher revision rates than components which utilize metal-backed implants. Further modifications in the design, indications, or technique may be necessary to improve outcomes of this unicompartmental knee arthroplasty system.     

Migration of activated CD8(+) T lymphocytes to sites of viral infection does not require endothelial selectins

Using mice deficient of E-selectin and E/P-selectin, we have studied the requirement for endothelial selectins in extravasation of leukocytes at sites of viral infection, with major emphasis on the recruitment of virus-specific T(C)1 cells. Lymphocytic choriomeningitis virus (LCMV)-induced meningitis was used as our primary experimental model. Additionally, localized subdermal inflammation and virus clearance in internal organs were analyzed during LCMV infection. The generation of CD8(+) effector T cells in infected mutants was unimpaired. Quantitative and qualitative analysis of the inflammatory exudate cells in intracerebrally infected mice gave identical results in all strains of mice. Expression of endothelial selectin was also found to be redundant regarding the ability of effector cells to eliminate virus in nonlymphoid organs. Concerning LCMV-induced footpad swelling, absent or marginal reduction was found in E/P-sel -/- mice, compared with wild-type mice after local challenge with virus or immunodominant viral MHC class I restricted peptide, respectively. Similar results were obtained after adoptive transfer of wild-type effector cells into E/P-sel -/- recipients, whereas footpad swelling was markedly decreased in P-sel/ICAM-1 -/- and ICAM-1 -/- recipients. LCMV-induced footpad swelling was completely inhibited in ICAM-deficient mice transfused with donor cell preincubated with soluble VCAM-1-Ig chimeric protein. Taken together, the current findings strongly indicate that the migration of T(C)1 effector cells to sites of viral infection can proceed in the absence of endothelial selectins, whereas ligands of the Ig superfamily are critically involved in this process. (Blood. 2000;95:1362-1369)     

Hyperalgesia and blunted morphine analgesia in G protein-gated potassium channel subunit knockout mice

Our aim was to determine whether G protein-gated potassium (Kir3) channels contribute to thermonociception and morphine analgesia. Western blotting was used to probe for the presence of Kir3.1, Kir3.2, Kir3.3, and Kir3.4 subunits in the mouse brain and spinal cord. Hot-plate paw-lick latencies for wild-type, Kir3.2 knockout, Kir3.3 knockout, and Kir3.4 knockout mice were measured at 52 degrees C and 55 degrees C, following the s.c. injection of either saline or 10 mg/kg morphine. Paw-lick latencies for Kir3.4 knockout mice were similar to those of wild-type mice, consistent with the restricted expression pattern of Kir3.4 subunit in the mouse brain. In contrast, Kir3.2 knockout and Kir3.3 knockout mice displayed hyperalgesia at both temperatures tested, and both Kir3.2 knockout and Kir3.3 knockout mice displayed shorter paw-lick latencies following morphine administration, with Kir3.2 knockout mice exhibiting the more dramatic phenotype. Kir3.2/Kir3.3 double knockout mice displayed a greater degree of hyperalgesia than either the Kir3.2 knockout or Kir3.3 knockout mice, while performing similarly to Kir3.2 knockout mice following morphine administration. We conclude that G protein-gated potassium channels containing Kir3.2 and/or Kir3.3 play a significant role in responses to moderate thermal stimuli. Furthermore, the activation of Kir3 channels containing the Kir3.2 subunit contributes to the analgesia evoked by a moderate dose of morphine. As such, receptor-independent Kir3 channel agonists may represent a novel and selective class of analgesic agent.