The Long-Term Footprint of Endometriosis: Population-Based Cohort Analysis Reveals Increased Pain Symptoms and Decreased Pain Tolerance at Age 46 Years

Previous studies have shown increased pain sensitivity in fertile-aged women with endometriosis in response to mechanical stimuli. As yet, population-based studies on the association of endometriosis with pain sensation and pain symptoms in late fertile age are lacking. The main objective of this population-based cohort study was to investigate whether a history of endometriosis is associated with altered pain sensation and musculoskeletal pain symptoms at age 46 years. Our data are derived from the Northern Finland Birth Cohort 1966, which contains postal questionnaire data (72% response rate) as well as clinical data assessing pressure-pain threshold and maximal pain tolerance. The study population consisted of 284 women with endometriosis and 3,390 controls. Our results showed that at age 46 women with a history of endometriosis had a 5.3% lower pressure-pain threshold and 5.1% lower maximal pain tolerance compared with controls. The most significant contributors besides endometriosis were anxiety, depression, and current smoking status. Women with endometriosis also reported an increased number of pain sites (0 pain sites, 9.6 vs 17.9%; 5-8 pain sites, 24.8 vs 19.1%, endometriosis vs controls respectively; P?<?.001), and their pain was more troublesome and intense. The results were adjusted for body mass index, smoking, depressive/anxiety symptoms, education, and use of hormonal contraceptives. These unique data revealed an altered pain sensation and a greater likelihood of reporting musculoskeletal pain at age 46 years among women with a history of endometriosis. The results imply that endometriosis has a long-term footprint on affected women, thus underlying the need for psychological support and medical treatment beyond fertile age.

Childhood trajectories of inattention-hyperactivity and academic achievement at 12 years

Few prospective studies spanning early childhood to early adolescence have examined separately the contribution of inattention and hyperactivity to academic achievement. The aim of the present study was to investigate whether the developmental trajectories of inattention and hyperactivity symptoms during early and middle childhood are independently associated with academic achievement at age 12 years. The independent associations between inattention and hyperactivity trajectories during early and middle childhood and academic performance at age 12 years were examined in a population-based longitudinal birth cohort (n = 2120). In adjusted analyses, high early childhood inattention trajectories were associated with teacher-rated academic performance in reading, writing and mathematics and with government exam score in writing. High and moderate inattention trajectories during middle childhood predicted lower performance on both teacher-rated academic performance and government exam scores in reading, writing, and mathematics. Hyperactivity was not a consistent predictor of educational outcomes. Childhood inattention symptoms rather than hyperactivity carry risk of poor educational outcomes at age 12 years. Children with high levels of inattention can be identified during the preschool years. Prevention programs supporting the development of attentional capacities and executive functions could help reduce the negative consequences of inattention.     

Influence of perineal prostatectomy on anal continence

OBJECTIVE:

Perineal prostatectomy has been proposed as a less invasive and safe procedure, but the risk of anal incontinence has been studied. This study aimed to evaluate the effects of perineal access on anal continence mechanisms after perineal prostatectomy.

METHODS:

From August 2008 to May 2009, twenty three patients underwent perineal prostatectomy. These patients were evaluated before surgery and eight months postoperatively using the Cleveland Clinic Anal Incontinence Score, the Fecal Incontinence Quality of Life Score, and anorectal manometry.

RESULTS:

The mean age of the subjects was 65 (range, 54-72) years, and the mean prostate weight was 34.5 (range, 24-54) grams. Gleason scores ranged from 6-7, and the mean Cleveland Clinic Anal Incontinence Score (mean±standard deviation) values were 0.9±1.9 and 0.7±1.2 (p>0.05) before and after surgery, respectively. The Fecal Incontinence Quality of Life Score did not change significantly after surgery. The mean values for anal manometric parameters before and after surgery were, respectively: Resting Pressures of 64±23 mmHg and 65±17 mmHg (p = 0.763), Maximum Squeezing Pressures of 130±41 mmHg and 117±40 mmHg (p = 0.259), High Pressure Zones of 3.0±0.9 cm and 2.7±0.8 cm (p = 0.398), Rectal Sensory Thresholds of 76±25 ml and 71±35 ml (p = 0.539), Maximum Tolerated Rectal Volumes of 157±48 ml and 156±56 ml (p = 0.836), and Sphincter Asymmetry Indexes 22.4±9% and 14.4±5% (p = 0.003).

CONCLUSION:

There was a significant decrease in the sphincter symmetry index after perineal prostatectomy. With the exception of the sphincter asymmetry index, perineal prostatectomy did not affect anal continence parameters.     

Influence of MK-467, a peripherally acting α2-adrenoceptor antagonist on the disposition of intravenous dexmedetomidine in dogs

Growing evidence supports the use of (2R-trans)-N-(2-(1,3,4,7,12b-hexahydro-2'-oxo-spiro(2H-benzofuro(2,3-a)quinolizine-2,4'-imidazolidin)-3'-yl)ethyl) methanesulfonamide (MK-467), a peripherally acting α(2)-adrenoceptor antagonist, in conjunction with the sedative-anesthetic agent dexmedetomidine in animals to avoid hemodynamic compromise. We evaluated the possible effects of different doses of MK-467 on the plasma concentrations of dexmedetomidine in eight beagle dogs. Both drugs were administered intravenously. Each dog received five treatments: dexmedetomidine alone (10 μg/kg), MK-467 alone (250 μg/kg), and dexmedetomidine (10 μg/kg) combined with different doses of MK-467 (250, 500, and 750 μg/kg) in a randomized, crossover fashion. Selected pharmacokinetic parameters were calculated. The area under the time-concentration curve of dexmedetomidine was significantly greater after dexmedetomidine alone (by 101 ± 20%, mean ± 95% confidence interval) compared with that after dexmedetomidine and 250 μg/kg MK-467. Increasing the dose of the antagonist had no further effect on the exposure to dexmedetomidine. The apparent volume of distribution of dexmedetomidine was significantly smaller after dexmedetomidine alone compared with that after all treatments that included MK-467. Dexmedetomidine (10 μg/kg) did not significantly influence the plasma concentrations of MK-467 (250 μg/kg). The results suggest that the peripherally acting α(2)-adrenoceptor antagonist MK-467 markedly influenced the early disposition of dexmedetomidine without obvious effects on the later plasma concentrations of the drug.     

Asthma and caries: a systematic review and meta-analysis

There is inconclusive evidence suggesting a possible association of asthma with increased risk of caries. The authors conducted a systematic review and meta-analysis to synthesize the evidence on the relation between asthma and caries. They performed an Ovid Medline (US National Library of Medicine) database search of literature published from 1950 through May 2010 using the Medical Subject Headings "asthma" and "caries." Summary effect estimates were calculated with fixed- and random-effects models, and determinants of heterogeneity were studied in meta-regression analysis. The meta-analysis was based on 11 articles providing estimates of the effect of asthma on primary dentition and 14 articles on permanent dentition. Summary effect estimates for the relation between asthma and caries from the random-effects models were 2.73 (95% confidence interval: 1.61, 4.64) and 2.04 (95% confidence interval: 1.44, 2.89), respectively. Factors identified as determinants of heterogeneity were geographic region for primary dentition and publication year, sample size, asthma definition, and information on the use of asthma medication for permanent dentition. Evidence from this analysis suggests that asthma doubles the risk of caries in both primary and permanent dentition. Publication bias diagnostics and simulation suggested possible overestimation of the summary odds ratio for permanent dentition but not for primary dentition. Physicians and dentists should recommend preventive measures against caries for persons with asthma.