CBP Patients Research Articles

A comparative imaging analysis of paraspinal muscles in healthy individuals and patients with chronic low back pain

BackgroundChronic low back pain (CBP) is a heterogeneous disease that may be caused by intervertebral disc lesions, age-related degenerative lumbar vertebral bodies, nerve compressions at its exit points, age-related weakness of paraspinal muscles, or tendinous and myofascial causes. This study compared the changes in the cross-sectional area (CSA) of the paraspinal muscles between healthy individuals and patients with CBP at the L4 superior endplate level. MethodsMagnetic Resonance (MR) Images of 50 healthy males without a history of back pain and 50 patients with CBP aged 40–60 years were retrospectively evaluated. The CSAs of the bilateral paraspinal muscles viz multifidus, erector spinae, psoas major, and quadratus lumborum were measured in the axial view at the level of the L4 superior endplate. The sagittal view of the MRI images at the L4 superior endplate level was selected to evaluate intervertebral disc (IVD) abnormalities. Further, these images were subjected to the Tissue Quant algorithm to quantify muscle atrophy and fat deposition. ResultsSagittal section images showed diffuse bulges in the IVD of 28 patients with CBP rather than IVD extrusion or protrusion. Decreased multifidus CSA and a marginal increase in CSA of other paraspinal muscles were observed in CBP patients along with significant fat infiltration within the paraspinal muscles. ConclusionThis study demonstrated a bilateral decrease in the CSA of multifidus muscles in patients with CBP compared with healthy individuals. In contrast, a slight increase in CSA was noted in the remaining paraspinal muscles, which may be due to reduced muscle mass and increased interfascicular fatty infiltration. Evaluating the manifestations of each paraspinal muscle and subsequent strengthening of the concerned muscle should be targeted for treating CBP.

Association of uncontrolled blood pressure in apparent treatment-resistant hypertension with increased risk of major adverse cardiovascular events plus.

Patients with apparent treatment-resistant hypertension (aTRH) are at increased risk of end-organ damage and cardiovascular events. Little is known about the effects of blood pressure (BP) control in this population. Using a national claims database integrated with electronic medical records, the authors evaluated the relationships between uncontrolled BP (UBP; ≥130/80mmHg) or controlled BP (CBP; <130/80mmHg) and risk of major adverse cardiovascular events plus (MACE+; stroke, myocardial infarction, heart failure requiring hospitalization) and end-stage renal disease (ESRD) in adult patients with aTRH (taking ≥3 antihypertensive medication classes concurrently within 30 days between January 1, 2015 and June 30, 2021). MACE+ components were also evaluated separately. Multivariable regression models were used to adjust for baseline differences in demographic and clinical characteristics, and sensitivity analyses using CBP<140/90mmHg were conducted. Patients with UBP (n=22333) were younger and had fewer comorbidities at baseline than those with CBP (n=11427). In the primary analysis, which adjusted for these baseline differences, UBP versus CBP patients were at an 8% increased risk of MACE+ (driven by a 31% increased risk of stroke) and a 53% increased risk of ESRD after 2.7 years of follow-up. Greater MACE+ (22%) and ESRD (98%) risk increases with UBP versus CBP were seen in the sensitivity analysis. These real-world data showed an association between suboptimal BP control in patients with aTRH and higher incidence of MACE+ and ESRD linked with UBP despite the use of multidrug regimens. Thus, there remains a need for improved aTRH management.

Incidence and Factors Associated with Uncontrolled Hypertension at 12 months after Kidney Transplantation in Saudi Arabia

Introduction: Uncontrolled blood pressure (uBP) after kidney transplantation (KTx) is very common and is associated with significant morbidity. However, studies that assess its incidence and risk factors are limited and outdated in the Middle East. Methods: This is a single-center retrospective study of KTx recipients (KTRs) in our center between January 2017 and May 2020 with a 12-month follow-up period. The target of hypertension treatment during the time of this study was <140/90 mm Hg, according to the published guidelines. We divided patients according to their blood pressure (BP) control at 1 year into two groups: controlled BP (cBP) (<140/90) and uBP (≥140/90). We studied the association between uBP and patients’ demographics, baseline cardiovascular risk factors, and changes in their metabolic and cardiovascular profile during the first 12 months post-KTx. Results: A total of 254 KTRs were included. 79.2% developed post-KTx hypertension, 74% were ≥30 years, 58% were men, and 80% were living donor KTRs. The renal replacement modality among our patients pre-KTx was hemodialysis in 78.4%, peritoneal dialysis in 11.5%, and 10.1% underwent preemptive transplantation. At 1 year, 76 (29.9%) KTRs did not attain the target BP goal. Systolic BP (SBP) decreased from baseline to 12 months by 13 ± 24 mm Hg in the cBP group and increased by 8.7 ± 21 mm Hg in the uBP group (p < 0.001). Additionally, diastolic BP (DBP) decreased by 8.5 ± 16.9 mm Hg in the cBP group and increased by 2.3 ± 18.8 mm Hg in the uBP group (p < 0.001). Factors associated with uBP included age (47 vs. 41 years, p = 0.008) and diabetes mellitus (p = 0.012). Contrarily, gender, dialysis vintage, preemptive transplantation, type of dialysis (hemodialysis vs. peritoneal dialysis), type of transplant (living donor KTx vs. deceased donor KTx), and smoking were not different among the two groups. There were no significant differences between the two groups in regard to changes in creatinine, weight, A1c, low-density lipoprotein, and parathyroid hormone levels. Additionally, rate of rejection, new onset diabetes post-transplant, and persistent hyperthyroidism were not different between the groups. However, higher body mass index at 12 months was associated with a higher incidence of uBP (27.2 ± 5.9 vs. 29.2 ± 5.4, p = 0.013). Using multivariate analysis, we found that serum creatinine at 12 months was the only predictor of uBP (OR = 1.005 [1–1.011], p = 0.036). Conclusion: At 1-year post-renal transplantation, about one-third of KTRs had uBP despite multiple antihypertensive medications. SBP and DBP significantly trended upward after transplantation in uBP patients, whereas SBP and DBP significantly trended downward after transplantation in cBP patients. Serum creatinine at 12 months was the only factor independently associated with uBP.

Abstract 13365: Real World Clinical Outcomes Associated With Controlled versus Uncontrolled Blood Pressure in Patients With Apparent Treatment Resistant Hypertension

AHA estimated 10.3 million US adults with apparent treatment resistant hypertension (aTRH) in 2018; limited data exist regarding clinical outcomes for these patients. This retrospective cohort study assessed risk of major adverse cardiac events (MACE: stroke, myocardial infarction, heart failure hospitalization) and end stage renal disease (ESRD) among aTRH patients, comparing those with controlled blood pressure (CBP; SBP/DBP &lt;130/80 mm Hg) vs uncontrolled blood pressure (UBP; ≥130/80 mm Hg), using linked IQVIA Ambulatory EMR- US and IQVIA PharMetrics® Plus claims data. Patients taking ≥3 antihypertensive (anti-HTN) classes within 30 days (index regimen) between 1/1/2015 and 6/30/2021, having ≥2 BP values post-index regimen (2 nd BP date = index date) with ≥12 months pre-index enrollment (baseline) were included. Unbalanced covariates were adjusted in the multivariable model. Cohorts consisted of 11,427 CBP and 22,333 UBP patients: mean (SD) age 62 (13) vs 60 (12) years, female (48% vs 46%), African-American (8% vs 12%), mean (SD) baseline SBP/DBP 118 (8)/70 (6) vs 141 (14)/82 (9) mm Hg, mean (SD) BMI 32 (8) vs 34 (10) kg/m 2 , respectively. The index regimen consisted of 3, 4, or ≥5 anti-HTN classes in 82% vs 79%, 15% vs 18%, and 2% vs 3% of CBP vs UBP patients, respectively (all p&lt;0.001). Frequently observed baseline comorbidities in CBP vs UBP patients included hyperlipidemia (79% vs 76%), mild to moderate diabetes (43% vs 42%), chronic pulmonary disease (31% vs 25%), and congestive heart failure (27% vs 16%). Mean (SD) follow-up time was 2.7 (2.1) years for both cohorts. Patients with UBP were at 8% and 53% increased risk of developing MACE and ESRD, respectively, MACE risk was mainly driven by a 31% increased risk of stroke (figure). Despite being treated with 3+ anti-HTN classes, 66% of aTRH patients had UBP and demonstrated increased risk of MACE and ESRD compared to CBP patients. Development of future innovative treatment approaches can add value in the management of aTRH.

CARDIAC PROTECTION THERAPY CAN PREVENT THE ELEVATION OF CENTRAL BLOOD PRESSURE IN ADULT PATIENTS WITH CONGENITAL HEART DISEASE

Objective: There is no evidence of beneficial effect of cardiac protection (CP) therapy for heart failure, that is medication of renin-angiotensin system antagonists and beta blockers, in patients with congenital heart disease (CHD). However, these drugs have blood pressure (BP) lowering effect and may prevent future hypertension in CHD patients, who are high risk for hypertension. Therefore, we examine the BP lowering effect of CP in adults with CHD. Design and method: We enrolled 131 consecutive subjects aged &gt; 20 years who visited the Department of Adult Congenital Heart Disease, Chiba Cardiovascular Center. The exclusion criteria were as follows: (1) a history of atrial fibrillation or frequent supra or ventricular premature beats, (2) history of cardiac operation in the past 6 months, (3) medication for hypertension, and (4) NYHA II-IV. We divided the remaining 60 patients into cardiac protection (+) and (-) and compared their brachial and central systolic BP (SBP). We defined a patient whose brachial SBP was higher than 1SD of age and sex matched control (Japanese general population) as high SBP. Moreover, we defined a patient whose central SBP was higher than 1SD of control as high central SBP. Results: Fifteen patients were medicated CP drugs (carvedilol 7, bisoprolol 1, enalapril 11, candesartan 2) (CP+). The mean age was 34.1 ± 13.2 years in CP- and 30.3 ± 11.4 in CP+. The brachial systolic/diastolic BP was 124.4 ± 19.7/74.6 ± 14.0 mmHg in CP- 116.7 ± 12.5/66.2 ± 12.1 mmHg in CP+. There were 14 high SBP patients in CP- and one patient in CP+ (p = 0.0535). The central SBP was 126.8 ± 21.0 mmHg in CP- and 113.2 ± 16.0 mmHg in CP+. There were 16 high central CBP patients in CP- and one patient in CP+ (p = 0.0043). Conclusions: The number of high central SBP in patients with CP+ was smaller than CP-. It may be obvious because the drugs used for CP have BP lowering effect. It is well known that hypertension is popular in patients with CHD. CP drugs for heart failure may prevent future cardiovascular disease in patients with CHD.

Identification of an Autoantibody Against ErbB-3-Binding Protein-1 in the Sera of Patients With Chronic Hepatitis B Virus Infection.

BackgroundStudies have shown that autoimmune response contributes to chronic hepatitis B (CHB) development.AimThis study aimed to identify autoantibodies in the sera of patients with CHB and to investigate the association of autoimmune response with disease severity in CHB.MethodsProteins from human liver carcinoma cell line HepG2 were separated by two-dimensional electrophoresis. The candidate autoantigens were recognized by serum autoantibodies from Chinese CHB patients. Immunohistochemical staining was performed to determine the hepatic expression of the autoantigen in CHB patients with different inflammatory grades. Enzyme-linked immunosorbent assay (ELISA) was conducted to measure the prevalence and the levels of serum autoantibody in CHB patients with different disease severity. Flow cytometry analysis was carried out to assess the autoreactive T cell response in the peripheral circulation of CHB patients.ResultsErbB-3-binding protein-1 (EBP-1) was identified as an autoantigen of serum autoantibodies in CBP patients. EBP-1 protein expression was upregulated in the liver of CHB patients with high-grade hepatic inflammation. The prevalence and levels of serum anti-EBP1 IgG were significantly increased in CHB patients with severe diseases compared with those with mild or moderate diseases, but none was detectable in the healthy controls. EBP-1 peptides induced proinflammatory cytokine expression in CD4+ T cells from CHB patients.ConclusionOur results demonstrate the presence of an autoantibody against EBP-1 in the sera as well as EBP-1-reactive T cells in the peripheral blood of CHB patient. EBP-1-induced autoimmune response is positively associated with the disease severity, suggesting that EBP-1-induced autoimmune response possibly contributes to progressive liver failure.

Regulatory T cell subsets in bullous pemphigoid and dipeptidyl peptidase-4 inhibitor-associated bullous pemphigoid

BackgroundRegulatory T (Treg) cells play an essential role in peripheral immune tolerance. Bullous pemphigoid (BP) is the most common blistering disease and is caused by autoantibodies to two BP antigens: type XVII collagen and BP230. Recently, we reported that Treg cell dysfunction may cause the production of autoantibodies to BP antigens. Several studies have suggested an association between Treg cells and BP pathogenesis. However, Treg cells are heterogeneous in humans, leading to inconsistent results in previous studies. ObjectiveTo assess functional Treg subsets in BP. MethodsWe examined three distinct Treg subsets in conventional BP (cBP) patients before versus after systemic corticosteroid treatment, dipeptidyl peptidase-4 inhibitor-associated BP (DPP-4i-BP) patients, younger controls and older controls. ResultsWe found that total Treg cells and all Treg cell subsets were increased in cBP patients before treatment and decreased by systemic corticosteroid treatment. In contrast, neither total Treg cells nor all Treg subsets were increased in DPP-4i-BP. Notably, CD45RA− Foxp3hi effector Treg cells positively correlated with disease severity in cBP, whereas CD45RA+Foxp3lo naïve Treg cells positively correlated with the disease severity in DPP-4i-BP. ConclusionThese findings suggest that Treg cells are differently involved in the pathogeneses of cBP and DPP-4i-BP.

A Web- and Mobile-Based Intervention for Comorbid, Recurrent Depression in Patients With Chronic Back Pain on Sick Leave (Get.Back): Pilot Randomized Controlled Trial on Feasibility, User Satisfaction, and Effectiveness.

BackgroundChronic back pain (CBP) is linked to a higher prevalence and higher occurrence of major depressive disorder (MDD) and can lead to reduced quality of life. Unfortunately, individuals with both CBP and recurrent MDD are underidentified. Utilizing health care insurance data may provide a possibility to better identify this complex population. In addition, internet- and mobile-based interventions might enhance the availability of existing treatments and provide help to those highly burdened individuals.ObjectiveThis pilot randomized controlled trial investigated the feasibility of recruitment via the health records of a German health insurance company. The study also examined user satisfaction and effectiveness of a 9-week cognitive behavioral therapy and Web- and mobile-based guided self-help intervention Get.Back in CBP patients with recurrent MDD on sick leave compared with a waitlist control condition.MethodsHealth records from a German health insurance company were used to identify and recruit participants (N=76) via invitation letters. Study outcomes were measured using Web-based self-report assessments at baseline, posttreatment (9 weeks), and a 6-month follow-up. The primary outcome was depressive symptom severity (Center for Epidemiological Studies–Depression); secondary outcomes included anxiety (Hamilton Anxiety and Depression Scale), quality of life (Assessment of Quality of Life), pain-related variables (Oswestry Disability Index, Pain Self-Efficacy Questionnaire, and pain intensity), and negative effects (Inventory for the Assessment of Negative Effects of Psychotherapy).ResultsThe total enrollment rate with the recruitment strategy used was 1.26% (76/6000). Participants completed 4.8 modules (SD 2.6, range 0-7) of Get.Back. The overall user satisfaction was favorable (mean Client Satisfaction Questionnaire score=24.5, SD 5.2). Covariance analyses showed a small but statistically significant reduction in depressive symptom severity in the intervention group (n=40) at posttreatment compared with the waitlist control group (n=36; F1,76=3.62, P=.03; d=0.28, 95% CI −0.17 to 0.74). Similar findings were noted for the reduction of anxiety symptoms (F1,76=10.45; P=.001; d=0.14, 95% CI −0.31 to 0.60) at posttreatment. Other secondary outcomes were nonsignificant (.06≤P≤.44). At the 6-month follow-up, the difference between the groups with regard to reduction in depressive symptom severity was no longer statistically significant (F1,76=1.50, P=.11; d=0.10, 95% CI −0.34 to 0.46). The between-group difference in anxiety at posttreatment was maintained to follow-up (F1,76=2.94, P=.04; d=0.38, 95% CI −0.07 to 0.83). There were no statistically significant differences across groups regarding other secondary outcomes at the 6-month follow-up (.08≤P≤.42).ConclusionsThese results suggest that participants with comorbid depression and CBP on sick leave may benefit from internet- and mobile-based interventions, as exemplified with the positive user satisfaction ratings. The recruitment strategy via health insurance letter invitations appeared feasible, but more research is needed to understand how response rates in untreated individuals with CBP and comorbid depression can be increased.Trial RegistrationGerman Clinical Trials Register DRKS00010820; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00010820.

Are gender-specific approaches needed in diagnosing early axial spondyloarthritis? Data from the SPondyloArthritis Caught Early cohort

BackgroundAlthough gender differences have been observed in the severity of axial spondyloarthritis (axSpA), gender differences in disease presentation of early axSpA have not been thoroughly investigated. In particular, their impact on the diagnostic process is unknown.MethodsBaseline data from the SPondyloArthritis Caught Early cohort, which includes patients with chronic back pain (CBP; duration ≥ 3 months and ≤ 2 years, age of onset < 45 years), were analysed. Patients underwent a full diagnostic work-up, including MRI and radiograph of the sacroiliac joints (MRI-SIJ and X-SIJ), to establish a diagnosis of axSpA. Characteristics of male and female patients with a certain diagnosis of axSpA (confidence level by the physician ≥ 7 on a 0–10 rating scale) were compared. Regression models were built for: the whole CBP cohort stratified by gender, to study which SpA features were associated most with diagnosis in each gender; and for axSpA patients, to test whether gender was associated with imaging positivity (MRI-SIJ+ and/or X-SIJ+).ResultsOf the 719 CBP patients, 275 were male. With 146/275 males and 155/444 females diagnosed as axSpA, males were more likely to be diagnosed with axSpA (OR 2.1, 95% CI 1.5–2.9). Despite similar symptom duration, male axSpA patients were younger at diagnosis (27.4 ± 7.5 vs 29.5 ± 7.8 years; p = 0.02). Presence of SpA features was similar in male and female axSpA patients, except for HLA-B27 and imaging positivity that were more common in male axSpA patients (80% vs 60%; p < 0.01 and 78% vs 64%; p = 0.01). Nevertheless, these SpA features were still more prevalent in female axSpA patients than in no-axSpA patients, both females (HLA-B27+ 23%, positive imaging 7%) and males (HLAB27+ 34%, positive imaging 11%) (all p < 0.01). Moreover, in multivariable models with diagnosis of axSpA as outcome, HLA-B27 and imaging positivity were associated with the diagnosis in both sexes. In models with imaging positivity as outcome, male gender and HLA-B27 were both independently associated with MRI+ and/or X-SI+.ConclusionsWhile our data show clear gender differences in early axSpA, they highlight that HLA-B27 and imaging are still key elements for diagnosis in both genders. Our study does not suggest that separate diagnostic strategies for men and women are required.

Association of antepartum blood pressure levels and angiogenic profile among women with chronic hypertension.

Angiogenic factors have been implicated in the pathogenesis of preeclampsia. This pilot study explored the association between antenatal blood pressure levels and angiogenic biomarkers (sFlt1 and PlGF) among women with chronic hypertension (cHTN). Blood samples were collected from women with cHTN (with/without superimposed preeclampsia) within 96 h prior to delivery. Subjects were stratified by mean outpatient BP as controlled (cBP < 140/90) or uncontrolled (uBP ≥ 140/90). Descriptive statistics were generated and assessed as appropriate. Logistic regression was employed to assess for adverse pregnancy outcomes between groups. Data from seventy-eight women were analyzed, of which 58 (74.4%) were African American. Fifty-six (71.8%) had cBP and 22 (28.2%) had uBP. Use of antepartum outpatient antihypertensive medications was more frequent in patients with uBP (46.4% vs. 13.6%, p = 0.01). Compared to women with cBP, women with uBP had higher levels of pre-delivery sFlt1 and sFlt1/PlGF ratio (sFlt: 4218.5 vs. 3056.0 pg/ml, p = 0.046; sFlt/PlGF: 62.5 vs. 25.0, p = 0.04). Additionally, more uBP patients had superimposed preeclampsia with severe features (54.6% vs. 25.0%; p = 0.01) and preterm delivery (defined as a gestational age <35 weeks (40.9% vs. 10.7%; p = 0.002)) than cBP patients. In the multivariable model, women with uBP had greater odds of preterm delivery (OR 6.78; p = 0.01), superimposed preeclampsia (OR 3.20; p = 0.03) and preeclampsia with severe features (OR 3.27; p = 0.04) than women with cBP. In women with cHTN, elevated antepartum BP is associated with worsened outcomes and may be associated with abnormal angiogenic profile at delivery. Larger studies are needed to confirm these findings.

Association of Antepartum Blood Pressure and Angiogenic Profile in Women With Chronic Hypertension [3OP

INTRODUCTION: This pilot study explored the association between antenatal blood pressure (BP) and angiogenic biomarkers (sFlt and PlGF) at delivery among women with chronic hypertension (cHTN). METHODS: Blood samples were collected within 96 hours of delivery. Mean outpatient BP was stratified as controlled (cBP&lt;140/90) or uncontrolled (uBP≥140/90). Angiogenic factors were measured on an automated platform. Descriptive statistics were assessed with Wilcoxon Rank Sum or chi-square tests, as appropriate. Logistic regression was employed to assess for adverse pregnancy outcomes. RESULTS: Of the 78 women enrolled, 58 (74.3%) were African American and 22 (28.2%) had uBP. There was no difference between cBP and uBP in age, race, ethnicity, BMI, smoking/substance abuse, parity, or previous preeclampsia (preE) diagnosis. A higher proportion cBP patients did not use a HTN agent (46.4% vs 13.6%, P=.01), although aspirin usage did not differ. Women with uBP had higher levels of sFlt1 and sFlt1/PlGF (sFlt: 4218.5 vs 3056.0 pg/mL, P=.046; sFlt/PlGF: 62.5 vs. 25.0, P=.04). A greater proportion of uBP vs. cBP patients had superimposed (SI) preE with severe features (preE-SF) (54.6% vs. 25.0%; P=.01), preterm delivery (40.9% vs. 10.7%; P=.002), and more admissions to rule out preE (77.3% vs. 30.4%; P=.0002). In the multivariable model, women with uBP had greater odds of preterm delivery (OR: 6.78; P=.01), SI preE (OR: 3.20; P=.03) and SI preE-SF (OR: 3.27; P=.04). CONCLUSION: Antepartum control of BP is associated with a favorable angiogenic profile at delivery and improved outcomes among women with cHTN. Larger studies are needed to confirm these findings.

Oxidation Reduction Potential (ORP) is Predictive of Complications Following Pediatric Cardiac Surgery

Oxidation reduction potential (ORP) or Redox is the ratio of activity between oxidizers and reducers. Oxidative stress (OS) can cause cellular injury and death, and is important in the regulation of immune response to injury or disease. In the present study, we investigated changes in the redox system as a function of cardiopulmonary bypass (CPB) in pediatric patients. 664 plasma samples were collected from 162 pediatric patients having cardiac surgery of various CPB times. Lower ORP values at 12h post-CPB were associated with poor survival rate (mean±SD 167±20 vs. 138±19, p=0.005) and higher rate of thrombotic complications (153±21 vs. 168±20, p<0.008). Similarly, patients who developed infections had lower ORP values at 6h (149±19 vs. 160±22, p=0.02) and 12h (156±17 vs. 168±21, p=0.004) post-CPB. Patients that developed any post-operative complication also had lower 6h (149±17 vs. 161±23, p=0.002) and 12h (157±18 vs. 170±21, p=0.0007) post-CPB ORP values. Free hemoglobin and IL-6, IL-10, and CRP were not associated with ORP levels. However, higher haptoglobin levels preoperatively were protective against decreases in ORP. Decreased ORP is a marker for poor outcome and predictive of post-operative thrombosis, infection, and other complications in critically ill pediatric cardiac surgery patients. These results suggest that redox imbalance and OS may contribute to the risk of complications and poor outcome in pediatric CBP patients. Haptoglobin may be a marker for increased resilience to OS in this population.

Risk and protective factors in the clinical rehabilitation of chronic back pain.

ObjectivesChronic back pain (CBP) can lead to disability and burden. In addition to its medical causes, its development is influenced by psychosocial risk factors, the so-called flag factors, which are categorized and integrated into many treatment guidelines. Currently, most studies investigate single flag factors, which limit the estimation of individual factor significance in the development of chronic pain. Furthermore, factors concerning patients’ lifestyle, biography and treatment history are often neglected. Therefore, the objectives of the present study are to identify commonly neglected factors of CBP and integrate them into an analysis model comparing their significance with established flag factors.MethodsA total of 24 patients and therapists were cross-sectionally interviewed to identify commonly neglected factors of CBP. Subsequently, the impact of these factors was surveyed in a longitudinal study. In two rehabilitation clinics, CBP patients (n = 145) were examined before and 6 months after a 3-week inpatient rehabilitation. Outcome variables, chronification factor pain experience (CF-PE) and chronification factor disability (CF-D), were ascertained with confirmatory factor analysis (CFA) of standardized questionnaires. Predictors were evaluated using stepwise calculations of simple and multiple regression models.ResultsThrough interviews, medical history, iatrogenic factors, poor compliance, critical life events (LEs), social support (SS) type and effort–reward were identified as commonly neglected factors. However, only the final three held significance in comparison to established factors such as depression and pain-related cognitions. Longitudinally, lifestyle factors found to influence future pain were initial pain, physically demanding work, nicotine consumption, gender and rehabilitation clinic. LEs were unexpectedly found to be a strong predictor of future pain, as were the protective factors, reward at work and perceived SS.DiscussionThese findings shed insight regarding often overlooked factors in the development of CBP, suggesting that more detailed operationalization and superordinate frameworks would be beneficial to further research.ConclusionIn particular, LEs should be taken into account in future research. Protective factors should be integrated in therapeutic settings.

Non-bullous lesions as the first manifestation of bullous pemphigoid: A retrospective analysis of 181 cases.

The aim of the present study was to explore the clinical and histopathological characteristics and treatment of patients with bullous pemphigoid (BP) that initially manifested as non-bullous lesions and provide information for early diagnosis and improved treatment. Medical records of 491 cases of BP were collected. The clinical and histopathological characteristics, treatment and outcomes of patients who initially presented with non-bullous lesions (prodromal BP, PBP) were analyzed and compared with those from patients who initially presented with bullous lesions (classical BP, cBP). Of the BP patients studied, 36.8% had PBP and presented with diversified initial lesions before the appearance of typical bullae, with erythema as the most frequent (31.67%), followed by concurrent erythema and papules (30.4%). The mean duration before bullae appearance was 15.91 ± 0.65 months. The degree of itch in PBP patients was higher than that in cBP patients. There was no difference in the hospital stay and time to disease control between the PBP and cBP patients. However, the mean glucocorticoid dose for control of the lesions in PBP patients was significantly higher than that in cBP patients. In addition, the PBP patients experienced side-effects more frequently than did the cBP patients (87.85% vs 17.41%). In conclusion, intensive treatment is required for PBP patients due to delayed diagnosis and advanced development of the disease. Itching, concurrent erythema and papules occurring in the elderly may be clues for the early diagnosis of PBP.

Classifying Back Pain and Peripheral Joint Complaints in Inflammatory Bowel Disease Patients: A Prospective Longitudinal Follow-up Study

Peripheral joint complaints [pJTC] and chronic back pain [CBP] are the most common extra-intestinal manifestations in patients with inflammatory bowel disease [IBD]. This prospective study evaluates variables associated with joint/back pain, including IBD disease activity. IBD patients with back pain ≥ 3 months and/or peripheral joint pain/swelling [n = 155], and IBD patients without joint complaints [n = 100; controls], were followed for a period of 1 year. Patients were classified as having SpondyloArthritis [SpA] according to several sets of criteria. Statistical analysis included logistic regression models and linear mixed model analysis. Of the 155 patients with joint/back pain, 13 had chronic back pain, 80 peripheral joint complaints, and 62 axial and peripheral joint complaints. Smoking, female gender, and IBD disease activity were independently associated with IBD joint/back pain. The Assessment in Spondyloarthritis International Society criteria for axial and peripheral SpA were fulfilled in 12.3% of patients, with 9.7% [n = 15] receiving a rheumatological diagnosis of arthritis. During the 12-month follow-up, the majority of the patients reporting joint/back pain remained stable. In our cohort, the majority of IBD patients reported joint/back pain and SpA was relatively common. To facilitate effective care, gastroenterologists should be aware of the various features of SpA to classify joint complaints and, by making use of an efficient referral algorithm, to refer CBP patients to the rheumatologist.

The effect of chronic bacterial prostatitis on semen quality in adult men: a meta-analysis of case-control studies.

Chronic bacterial prostatitis (CBP) is caused by bacterial infection and maintains a condition of lower urinary tract infection. It may be a cause of male infertility. However, studies showed inconsistent results regarding the effect of CBP on several parameters of semen. Hence, we conducted a meta-analysis to examine the effect of CBP on basic semen parameters. A systematic review was conducted with Medline, PubMed, EMBASE, and two Chinese databases (CNKI and WANG FANG) to identify relevant studies that involved the effect of CBP on semen parameters up to July 2014. Both RevMan5.2 and STATA 12.0 software were used for the statistical analysis. Based on the inclusion and exclusion criteria, seven studies were included. The study illustrated that sperm vitality, sperm total motility, and the percentage of progressively motile sperm from CBP patients were significantly lower than controls (SMD(95%CI) −0.81[−1.14, −0.47], −1.00[−1.28, −0.73], −0.41 [−0.70, −0.12], P<0.05, respectively). However, CBP had no significant effect on semen volume, sperm concentration and the duration of semen liquefaction. In summary, our study revealed that there was a significant negative effect of CBP on sperm vitality, sperm total motility, and the percentage of progressively motile sperm. Additional, studies with larger number of subjects are needed.

Pain Characteristic Differences Between Subacute and Chronic Back Pain

Back pain is commonly classified based on duration. There is currently limited information regarding differences in the clinical features of back pain between these duration-based groupings. Here, we compared the pain characteristics of patients with subacute (SBP; pain 6–16 weeks, n = 40) and chronic back pain (CBP; pain ≥1 year, n = 37) recruited from the general population. CBP patients reported significantly higher pain intensity on the Visual Analogue Scale (VAS) compared to SBP patients. Based on this finding, we investigated group differences and their dependence on VAS for the Beck Depression Inventory (BDI), sensory and affective dimensions of the McGill Pain Questionnaire (MPQ-S and MPQ-A), Neuropathic Pain Scale (NPS), and the variability of spontaneous pain. Correction for VAS abolished significant group differences on the MPQ-S, MPQ-A and NPS. Only a significant difference in the variability of spontaneous pain was independent of VAS. Finally, whereas SBP patients displayed a higher incidence of unilateral pain radiating down the legs/buttocks, there was a shift towards more bilateral pain in CBP patients. In summary, SBP and CBP groups differ on 3 independent parameters: VAS ratings, pain location, and temporal dynamics of spontaneous pain. Perspective The present study reports differences in the characteristics of back pain between duration-based groupings in the general population. The main outcome of the study is the demonstration that a small number of descriptors are required to characterize the difference between SBP and CBP.

Is Reynolds syndrome a genetic laminopathy?

Reynolds syndrome is a rare disease associating primary biliary cirrhosis (PBC) and systemic scleroderma (SSc). Although generally considered as an autoimmune disease owing to the presence of typical autoantibodies and to microscopical abnormalities suggesting autoimmunity (lymphoid infiltrate around the biliary ducts and the cutaneous vessels, pericarditis, pleurisy), other causes have been searched for, especially genetic. The discovery of a new mutation in the Lamin receptor B in a French patient suffering from Reynolds syndrome [1] revives this controversy. Laminopathies have a great variety of manifestations, but some are quite comparable with either SSc or PBC, and the new mutation has been found neither in a group of 27 other patients with SSc, nor in 400 normal subjects. After bioinformatics searching, the authors claim that it is plausible that the new mutation is pathogenic. It remains to be shown, however, that this is really the case by testing directly the liver and skin fibroblasts of the patient. Moreover, looking at a series of CBP patients and at a larger SSc sample will be enlightening to appreciate the real value of that discovery.

Antihypertensive treatment based on conventional or home blood pressure measurement - the thop trial

The hypothesis that self-measurement of BP at home (HBP) compared with conventional clinic measurement (CBP) would improve the management of hypertension was tested in a multicenter trial. Using a double-blind design, hypertensive patients (conventional DBP ≥ 95 mm Hg) were randomized to reach a target DBP from 80 through 89 mm Hg either on conventional measurement (CBP group) or on self-measurement at home (HBP group). Antihypertensive drug treatment was started at randomization in all patients and was stepwise adjusted at 7 follow-up visits. Net between-group differences were calculated by substracting mean changes from baseline in the CBP group (n=197) from those in the HBP group (n=203). All patients also underwent 24-h ABP monitoring at randomization and at the end of follow-up. Characteristics at baseline were similar in the 2 groups. Antihypertensive drug treatment was discontinued more frequently in HBP than CBP patients (25.2 vs. 12.3%, P=0.001). Slightly fewer HBP patients progressed to multiple drug treatment (38.7 vs. 46.4%, P=0.08). At the end of follow-up (median, 354 days), BP was higher (P<0.001) in HBP than CBP patients, regardless of the technique of BP measurement. The final between-group differences averaged: for CBP, 6.7/3.5 mm Hg (P<0.001); for HBP, 4.9/2.9 mm Hg (P<0.001); for daytime ABP, 5.1/3.1 mm Hg (P<0.001). The mean changes from baseline in electro- and echocardiographic indexes did not differ between HBP and CBP patients: for Sokolow-Lyon index, -0.159 vs. -0.080 mV (n=353, P=0.27); for LVMI, -16.1 vs. -6.8 g/m’b2 (n=50, P=0.16); for the E/A Doppler ratio, -0.04 vs. +0.16 (n=48, P=0.09). Compared to CBP, adjustment of antihypertensive therapy according to HBP led to less intensive drug treatment, but also to less BP reduction. Our findings suggest that with lower diagnostic thresholds than implemented in our trial, HBP measurements might be complementary to CBP and ABP in the management of hypertensive patients.

Semen Parameters in Men with and Without Proven Chronic Prostatitis

In patients with complaints of chronic prostatitis, analysis of prostatic secretions for leukocytes and the use of the four-specimen technique allow a distinct classification of chronic bacterial (CBP), nonbacterial prostatitis (NBP), and prostatodynia (Pd). In this study, 32 men with CBP, 102 men with NBP, 142 men with Pd, and 42 volunteers, classified as mentioned above, underwent a two-fold ejaculate analysis using WHO criteria. Sperm count, progressive motility, range of abnormal spermatozoa, increased numbers of common bacteria, and peroxidase-positive leukocytes were analyzed. Additionally, antibody-coated bacteria (ACB), numbers of ureaplasmas in semen, and urethral colonization by chlamydia were investigated. Mean values of sperm density, motility, and morphology revealed no differences between the groups. Significant bacteriospermia (greater than or equal to 10(3) bacterial/ml) was evident in only 47% of the CBP group versus 6.8% (NBP), 16% (Pd), and 4.2% (controls). ACB was positive in 31 of 32 men with CBP versus 3 of 102 with NBP, 9 of 142 with Pd, and none of the controls. Increased numbers of leukocytes were evident in CBP and NBP patients compared to the controls (p less than or equal to 0.001) but were also present in patients of the NBP and Pd groups with chlamydial infections.