Does severe acute pain provoke lasting changes in attentional and emotional mechanisms of pain-related processing? A longitudinal study

Pain experiences, learning, and genetic factors have been proposed to shape attentional and emotional processes related to pain. We aimed at investigating whether a singular major pain experience also changes cognitive-emotional processing. The influence of acute postoperative pain after cosmetic surgery of the thorax was tested in 80 preoperatively pain-free male individuals. Acute pain was measured as independent variable during the first week postsurgery by pain intensity ratings and the requested analgesic boluses (Patient-Controlled Epidural Analgesia (PCEA)). Pain catastrophizing (Pain Catastrophizing Scale (PCS)), pain anxiety (Pain Anxiety and Symptom Scale (PASS)), pain hypervigilance (Pain Vigilance and Awareness Questionnaire (PVAQ)), and attentional biases to emotionally loaded stimuli (including pain) in a dot-probe task were assessed 1 week, 3 months, and 6 months postsurgery as dependent variables. Hierarchical regression analyses were performed to test whether the 2 acute pain parameters can predict these cognitive-emotional variables. As a rigorous test, significant prediction was required in addition to the prediction of the dependent variables by themselves with lag-1. Acute pain (mainly the pain ratings) appeared to be a significant predictor for PCS, PASS, and PVAQ 1 week after surgery (deltaR² = [8.7% to 11.3%]). In contrast, the attentional biases in the dot-probe task could not be predicted by the pain ratings. The levels of pain catastrophizing and pain hypervigilance increased in the acute phase after surgery when influenced by acute pain and declined, along with pain anxiety, during the next 3 months. In conclusion, a one-time intense pain experience, such as acute postoperative pain, appeared to produce at least short-lived changes in the attentional and emotional processing of pain.     

Beneficial effects of angiotensin-converting enzyme inhibitor and nitrate association on left ventricular remodeling in patients with large acute myocardial infarction: the Delapril Remodeling after Acute Myocardial Infarction (DRAMI) trial

Background

In the large-scale trial, Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico-3 (GISSI-3), patients receiving the combination of lisinopril and glyceryl trinitrate benefited most from experimental therapy. Therefore, a multicenter, randomized, double-blind study, Delapril Remodeling After Acute Myocardial Infarction (DRAMI), was designed to assess (1) the possible additive beneficial effect on left ventricular remodeling of nitrates when combined with an angiotensin-converting enzyme inhibitor (ACEI), and (2) the tolerability of a new ACEI, delapril, in respect to lisinopril in patients with large myocardial infarction (MI).

Methods

A total of 177 patients were randomized to receive delapril plus isosorbide-5-mononitrate (IS5MN) placebo, delapril plus IS5MN, lisinopril plus IS5MN placebo, or lisinopril plus IS5MN starting within the first 36 hours after the onset of symptoms and continuing for 3 months.

Results

More than 80% of the patients showed extensive ST-segment changes and 36.7% had signs or symptoms of heart failure during the first 36 hours. Over 3 months, IS5MN reduced, by 76%, the increase in LVEDV (17.4 ± 5.0 mL placebo vs 4.2 ± 4.4 mL IS5MN, P = .0439), reversed the increase in LVESV (7.5 ± 3.9 mL placebo vs −5.5 ± 2.9 mL IS5MN, P = .0052), and increased the recovery of LVEF (1.9% ± 1.3% placebo vs 6.7% ± 1.2% IS5MN, P = .0119). Overall, 3-month mortality was 10.2%; the most frequent clinical events were new episodes of severe heart failure (18.1%), persistent hypotension (10.7%), and post-MI angina (18.1%), with no differences between treatment groups.

Conclusions

Administration for 3 months of IS5MN combined with an ACEI, both started within 36 hours from the onset of symptoms, was safe and effective in reducing LV dilation and dysfunction after MI. The 2 ACEIs, delapril and lisinopril, appeared to be equally well tolerated.     

Barriers to access intimate partner violence services in female Romanian immigrants in Spain: A Delphi study

Immigrant women may be at higher risk of intimate partner violence (IPV) and may seek specialized services less frequently than other populations. In Spain, Romanian origin foreigners comprise the second-highest proportion among immigrant population. This study aimed to identify, from the perspective of experts, (1) the main barriers faced by immigrant women of Romanian origin in accessing specialized services for IPV in Spain; and (2) the most useful strategies to combat these barriers. A Delphi study was conducted with a panel of 23 experts. The coefficient r_WG was calculated to established agreement among participants. The results showed 58 barriers and 31 strategies with high agreement among the experts (r_WG ≥ 0.80). Barriers in access to services that were considered to be highly influential included: having been in the host country for a short time; lack of language proficiency; job insecurity; difficulty with family-work reconciliation; and fear of the social consequences for help-seeking. The strategies considered most useful were: facilitating access to the job market and decent housing; promoting a social support network; translating material into Romanian; and increasing training among professionals. The findings offer guidelines for the improvement of the accessibility of specialized services to immigrant women of Romanian origin.     

Hierarchical tumor heterogeneity mediated by cell contact between distinct genetic subclones

Intratumor heterogeneity is an important mediator of poor outcomes in many cancers, including breast cancer. Genetic subclones frequently contribute to this heterogeneity; however, their growth dynamics and interactions remain poorly understood. PIK3CA and HER2 alterations are known to coexist in breast and other cancers. Herein, we present data that describe the ability of oncogenic PIK3CA mutant cells to induce the proliferation of quiescent HER2 mutant cells through a cell contact–mediated mechanism. Interestingly, the HER2 cells proliferated to become the major subclone over PIK3CA counterparts both in vitro and in vivo. Furthermore, this phenotype was observed in both hormone receptor–positive and –negative cell lines, and was dependent on the expression of fibronectin from mutant PIK3CA cells. Analysis of human tumors demonstrated similar HER2:PIK3CA clonal dynamics and fibronectin expression. Our study provides insight into nonrandom subclonal architecture of heterogenous tumors, which may aid the understanding of tumor evolution and inform future strategies for personalized medicine.     

Obesidad y SARS-CoV-2: consideraciones sobre la cirugía bariátrica y recomendaciones para el inicio de la actividad quirúrgica

The SARS-CoV-2 pandemic has a great impact worldwide, being Spain one of the most affected countries. The delay in bariatric surgery can have fatal consequences since up to 50% of the patients who are on the waiting list develop a new comorbidity during the time they remain on it and 1.5% of patients die while waiting for the intervention. That is why bariatric surgery should not be delayed, if the occupation of the hospital by COVID-19+ patients decreases significantly, and sufficient resources and safety are available to restart surgery in patients with benign pathology. This document contains the main recommendations for the bariatric surgery programs in our country from the point of view of safety, bariatric patient preparation and follow up during the SARS-CoV-2 pandemia.     

Drivers and consequences of self-immolation in parts of Iran,Iraq and Uzbekistan: A systematic review of qualitative evidence

ObjectivesThe prevalence of self-immolation is significantly higher in some Middle Eastern and Central Asian Islamic countries than in Western countries. Self-immolation typically occurs among females and can be either an attempt at suicide or an act of protest. This systematic review examined the drivers and consequences of self-immolation in Asian Islamic countries from the perspective of those affected by it, including survivors, family and health care staff in order to understand its higher prevalence in these countries.MethodA systematic review of qualitative studies was conducted in June 2018, using five electronic databases: PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), EMBASE, Scopus and PsycINFO. Of the 236 papers identified, seven met the inclusion criteria. Authors independently rated the reporting of included qualitative studies and thematic analysis was used to analyse the data.ResultsThe drivers of self-immolation included marital and familial conflict, male-dominated culture, mental health disorders and economic and social factors. Survivors chose self-immolation in order to express their sense of a lack of control and mostly utilised this method due to its accessibility. The consequences of self-immolation were social isolation, regret, and physical and psychological impacts.ConclusionsThe reasons for self-immolation, its prevalence and the demographics of those who choose this means vary significantly between Asian Islamic and Western countries. This review confirmed the impact of culture, tradition, and societal structures and relationships on people’s decisions to self-immolate. Education about the consequences of self-immolation may reduce the use of this method.     

Use of topical sevoflurane in pressure ulcer treatment in a double-lung transplant patient

Pain caused by wounds of different etiology is usually treated with oral analgesics. New topical use of products such as the ether anesthetic sevoflurane shows good results for pain control and has additional benefits. Pressure ulcers are painful and patients may benefit from the use of sevoflurane. We present the case of a double-lung transplant patient with a long-standing sacral pressure ulcer with poor pain control, for which sevoflurane dressings were used. The number of pain-free hours after application, the amount of daily analgesics and the size of the wound were monitored with the mobile wound application MOWA. After several days of sevoflurane application, the patient reduced analgesic consumption, remained longer free of pain, and the size of the wound decreased. Unfortunately, the patient had serious complications due to multiple comorbidities and died before the wound healed completely. Topical use of sevoflurane in pressure ulcers may be a good option to treat pain and improve patient quality of life.     

Factors associated with postsurgical wound infections among breast cancer patients: A retrospective case‐control record review

Women with non‐metastatic breast cancer will be offered surgery as their first option. Unfortunately, studies have shown that the most common postoperative complication is surgical wound infection (SWI). We investigated the prevalence of SWI in breast cancer patients and identified the factors predictive of its development. The study was conducted at the breast cancer centre in Singapore. A retrospective case‐control review of medical records was used. During the 2013 to 2016 study period, there were 657 postsurgical breast cancer patients with only 105 records eligible for the study. The sample consisted of one to four case:control (21:84), matched according to their age at the time of their surgery. Patients presenting with SWI were grouped into cases, while those without SWI were grouped into the controls. Chi‐square test and Mann‐Whitney U test were used to identify risk factors associated with SWI. Regression analysis of predictive variables from the univariate analyses was included. These variables were type of breast surgery, implants, comorbidities, previous surgery, previous chemotherapy, surgical drains, seroma, blood transfusion, surgeon department, and length of stay. The prevalence of SWI was 9%. Demographic, clinical, and comorbidities were not associated with SWI. However, multivariate analysis found that “surgeon department,” “discharged with surgical drains,” and “postoperative seroma” were predictive of SWI. Monitoring SWI is indispensable to minimise burdens on individuals and institutions. Health care professionals should identify high‐risk patients based on the identified predictive variables. A cross‐institutional record review of SWI in postoperative breast cancer patients should be conducted.