Course Of Treatments Research Articles

Improvement of Ulcerations in Treatment-Resistant Chronic Scarring in a Patient with Pyoderma Gangrenosum After Improving Vascular Insufficiency, Gently Removing Necrotic Debris, and Decreasing Wound Fluid.

Patient: Male, 44Final Diagnosis: Pyoderma gangrenosumSymptoms: Pain • ulceration • scarring • exudate • necrosisMedication: Clobetasol 0.5% ointment • Cadexomer iodine • PentoxifyllineClinical Procedure: Compression stocking application • leg elevation at nightSpecialty: Family MedicineObjective:Rare diseaseBackground:Classical pyoderma gangrenosum is a rare, inflammatory, neutrophilic dermatosis that commonly presents with severe ulcerations on the lower extremities and is often misdiagnosed and mistreated. Delay in treatments can lead to worsening of the ulcerations and allows for multiple comorbid factors. Pyoderma gangrenosum is most commonly treated with immunosuppressants or anti-inflammatory agents and is often worsened by surgical procedures due to the presence of pathergy. In acute cases, a course of anti-inflammatory treatments works well in alleviating symptoms and reducing ulcerations and residual scarring. However, in chronic cases with the presence of severe scarring and necrotic ulcerations, the simple implementation of systemic immunosuppressants is frequently ineffective alone. Although not mentioned in most case reports on pyoderma gangrenosum, the chronicity of its inflammatory component can lead to necrosis and scarring and subsequent vascular insufficiency.Case Report:We present a severe case of chronic ulcerative pyoderma gangrenosum in a patient who had treatment-resistant ulcerations and cribriform edematous scarring with subsequent vascular insufficiency of the right lower extremity. This patient, while receiving topical clobetasol, had marked improvement in the healing of his ulcerations only after starting a novel course of cadexomer iodine, compression stockings, and pentoxifylline.Conclusions:The efficacy of non-anti-inflammatory treatments indicates that chronic pyoderma gangrenosum with extensive scarring is commonly associated with the comorbid factors of vascular insufficiency, necrotic debris, and extensive wound fluid. In cases of ulcerations in chronic pyoderma gangrenosum that are resistant to anti-inflammatory treatments alone, one should identify and address other compounding factors that may inhibit wound healing.

Gender differences confirmed in cardiac surgery patients in cardiac rehabilitation

The leading cause of death in Europe is cardiovascular diseases (CVD), it causes 4 million deaths a year. Lithuania is classified as a high risk group of CVD. Many studies have shown that there are gender related differences in the way cardiac symptoms and diseases are perceived the incidence and course of coronary disease, cardiac treatments, and cardiac surgery. One hundred and twenty-five patients after cardiac surgery: valve surgery 37.8% ( n = 48), coronary artery bypass graft surgery (CABG) 52.8% ( n = 67), combined 9.4% ( n = 10) undergoing exercise training inpatient CR were studied in order to evaluate the effect of a CR programme on the quality of life. Functional capacity was assessed by a 6 minutes walking test and quality of life was assess by using the Short-Form (36) General Health Survey (assess patient's health and emotional well-being) scale from 1 to 100, on admission and at the end of 3 weeks programme. In the study participated 89 men (71.2%) and 36 women (28.8%). Men average age was 62.53 ± 1.85; women - 67.78 ± 1.6 ( P = 0.017). The prevalence of risk factors was not statistically significantly different between men and women ( P > 0.05). The physical capacity according to 6MWT was statistically significantly lower in women before and after CR (before 341.2 ± 24.1 vs. 246.2 ± 21.2 m., P = 0,004 after 417,1 ±13.29 vs. 341.2 ± 24.1, P = 0.009). Results of SF-36 general health assessment (45.9 ± 1.9% vs. 47.41 ± 3.5%) and emotional well-being (59.17 ± 2.81% vs. 62.4 ± 2.9%) at the beginning of CR did not differ (> 0.05). After CR women rated their general health (45.72 ± 2.36% vs. 54.4 ± 2.77%, P = 0.037) and emotional well-being (82.35 ± 2.65% vs. 71.2 ± 2.57%, P = 0.012) statistically significantly higher. In the female group, general health and emotional well-being assessment after CR were better evaluated, although women were older and their physical capacity was lower.

Identification of transcription factors from NF-Y, NAC, and SPL families responding to osmotic stress in multiple tomato varieties

Identifying osmotic stress-responsive transcription factors (TFs) can facilitate discovery of master regulators mediating salt and/or drought tolerance. To date, few RNA-seq datasets for high resolution time course of salt or drought stress treatments are publicly available for certain crop species. However, such datasets may be available for other crops, and in combination with orthology analysis may be used to infer candidate osmotic stress regulators across distantly related species. Here, we demonstrate the utility of this approach for identification and validation of osmotic stress-responsive transcription factors in tomato. First, we developed physiologically calibrated salt and dehydration-responsive systems for tomato cultivars using real time measurements of transpiration rate and photosynthetic efficiency. Next, we identified differentially expressed TFs in rice using raw RNA-seq datasets for a publicly available salt stress time course. Putative salt stress-responsive TFs in tomato were then inferred based on their orthology with the transcription factors upregulated by salt in rice. Finally, using our osmotic stress system, we experimentally validated stress-responsive expression of predicted tomato candidates representing NUCLEAR FACTOR Y, SQUAMOSA PROMOTER BINDING, and NAC domain TF families. Quantification of transcript copy numbers confirmed that mRNAs encoding all three TFs were strongly upregulated not only by salt but also by drought stress. Induction by both salt and dehydration occurred in a temporal manner across diverse tomato cultivars, suggesting that the identified TFs may play important roles in regulating osmotic stress responses.

Association between Dementia and Glycemic Control in Elderly Patients

Background: The goals of glycemic control based on their cognitive function are recommended for elderly patients. However, the recommendation of the glycemic control is different among the associations. That is, IDF and the Japan Diabetes Society set lower limit of HbA1c and ADA doesn’t. Moreover, there is not a clear course of treatments for elderly diabetics with dementia. Methods: We retrospectively assessed the correlation between blood glucose management and cognitive function of 616 outpatients aged 65 years or older who visited our hospital from March 14 to April 30, 2017. HbA1c, blood glucose level, and therapeutic agents were obtained from medical records. Cognitive function was evaluated with Dementia Assessment Sheet for Community-based Integrated Care System 21-items (DASC-21), which the Japan Diabetes Society and the Japan Geriatrics Society approve. The patients were allocated to three categories based on cognitive function (normal function: I, mild dementia: II, moderate and severe dementia: III), and two categories based on therapeutic agents (not using insulin, SU, or glinide: A, using insulin, SU, and/or glinide: B). Results: The numbers of the patients in IA, IB, IIA, IIB, IIIA, and IIIB were 138, 362, 11, 66, 7, and 32, respectively. The proportion of the patients whose HbA1c were below the lower limit was significantly higher in IIIB than that in IIB (43.8% vs. 19.7%, p <0.05). The proportion of the patients who underwent hypoglycemia (blood glucose <70 mg/dl) within recent 1 month was significantly higher in IIIB than that in IIB (28.1% vs. 18.2%, p <0.05). In IIIB, there were more hypoglycemic events in the patients whose HbA1c were above the lower limit than the patients whose HbA1c were below the lower limit (38.9% vs. 14.3%, p <0.05). Conclusions: This study shows that progression of cognitive impairment increases the risk of hypoglycemia. Moreover, this result suggests that the risk of hypoglycemia shouldn’t be evaluated only with HbA1c for elderly patients with dementia. Disclosure T. Yasuda: None. S. Muro: None. H. Fujita: None. M. Fujimura: None. T. Hatoko: None. E. Mori: None. S. Yonemitsu: None.

Distinct shifts in the oral microbiota are associated with the progression and aggravation of mucositis during radiotherapy

Background and purposeOral mucositis remains one of the most common complications of radiation therapy for patients with head and neck cancer. This study aimed to investigate the dynamic shifts in the oral mucosal microbiota and their association with the progression and aggravation of mucositis in patients with nasopharyngeal carcinoma (NPC) undergoing radiotherapy. Materials and methodsIn this study, oropharyngeal mucosa of patients were examined regularly, and sampled longitudinally in eight stages of their radiation treatment program: before radiation, and then after 10, 20, 30, 40, 50, 60, and 70 Gy. Based on 16S rRNA gene sequencing and bioinformatics analysis, the characteristics of dynamic variations in oral microbiota during their treatment were investigated. ResultsThe results showed that the mucosal bacterial alpha diversity (richness and evenness) did not change significantly during the entire course of these patient treatments. Notwithstanding 20 genera were found to be significantly positively associated with their radiation dose, whereas 10 genera were negatively associated with it. Notably, two bacterial co-abundance groups (CAG 1 and 2) were identified and the majority of bacteria clustered within the CAG 2 were indeed periodontal disease-associated genera. Most strikingly, many of them, especially Prevotella, Fusobacterium, Treponema and Porphyromonas, showed obvious dynamic synchronous variations in their abundances throughout the course of radiation therapy, where their peaks frequently coincided with the onset of severe mucositis. ConclusionOur results suggest that dysbiosis of oral mucosal microbiota may contribute to exacerbating the severity of mucositis in patients undergoing radiotherapy for nasopharyngeal carcinoma.

Structure and Magnetic Properties of Nd–Fe–B Magnets Prepared from DyH2-Containing Powder Mixtures

Sintered Nd–Pr–Dy–Fe–B permanent magnets were prepared by a powder blending technique using mixtures consisting of strip-casting alloy (wt %) 24.0 Nd, 6.5 Pr, 0.5 Dy, 1.0 B, 0.2 Al, 65.8 Fe and 2 wt % DyH2 dysprosium hydride. After optimum heat treatment of magnets at 500°C for 1 h, the following hysteretic characteristics were reached: remanence B r = 1.29 T; coercive force j H c = 1309 kA/m; critical field H k = 1220 kA/m; and the maximum energy product (BH)max = 322 kJ/m3. The characteristic peculiarity of the magnets prepared from hydride-containing power mixtures is the stability of hysteretic properties in the course of subsequent stepped annealings or progressive heatings at temperatures of 250–500°C for, in total, more than 20 h. Conditions of low-temperature annealings resulting in the degradation and subsequent restoration of hysteretic properties of magnets are determined. The evolution of the microstructure and phase composition of magnets in the course of heat treatments was studied by X-ray diffraction analysis and scanning electron microscopy, and the correlation between the structural changes and hysteretic properties of magnets is discussed.

Intensive cognitive rehabilitation therapy for chronic traumatic brain injury: a case study of neural correlates of functional improvement

ABSTRACTBackground: Some four million Americans are living with chronic disability related to traumatic brain injury (TBI). Yet, very little research has investigated training-induced neuroplasticity over many hours of treatment well into the chronic stage for the most commonly impaired functions (attention, executive functions (EFs), and prospective memory (PM)).Aims: The purpose of the present study was to investigate whether a 30-h course of intensive evidence-based treatments of attention, EFs, and PM would show behavioural gains and associated brain structural and/or functional changes in an individual well into the chronic phase of recovery from TBI.Methods & Procedures: An A-B single-participant quasi-experimental design with 1 month post-treatment follow-up was employed for cognitive rehabilitation of a 54-year-old man, 7.5 years after severe TBI. After an initial 4-week pre-treatment baseline phase, 30 hours of therapy was provided over 3 weeks, targeting attention, PM, and EFs, with follow-up testing at 1-month post-treatment. Treatments (selected from evidence-based practice guidelines) consisted of attention process training, metacognitive strategy instruction, and PM training. Neuroimaging (auditory oddball paradigm, resting state, and diffusion tensor imaging) was conducted weekly from the end of the A-phase, through the end of the B-phase, and then at 1-month follow-up.Outcomes & Results: Results demonstrated gains to behavioural and quality of life measures for attention and EFs, with evidence of associated structural and functional neuroplasticity. There was no evidence of change to PM skills.Conclusions: Intensive evidence-based treatment of attention and EFs improved functioning and quality of life in an individual well into the chronic phase of TBI, and may be associated with structural and functional neuroplasticity.

Treatment strategy for rod fractures following corrective fusion surgery in adult spinal deformity depends on symptoms and local alignment change.

OBJECTIVE Despite the significant incidence of rod fractures (RFs) following long-segment corrective fusion surgery, little is known about the optimal treatment strategy. The objectives of this study were to investigate the time course of clinical symptoms and treatments in patients with RFs following adult spinal deformity (ASD) surgery and to establish treatment recommendations. METHODS This study was a retrospective case series of patients with RFs whose data were retrieved from a prospectively collected single-center database. The authors reviewed the cases of 304 patients (mean age 62.9 years) who underwent ASD surgery. Primary symptoms, time course of symptoms, and treatments were investigated by reviewing medical records. Standing whole-spine radiographs obtained before and after RF development and at last follow-up were evaluated. Osseous union was assessed using CT scans and intraoperative findings. RESULTS There were 54 RFs in 53 patients (mean age 68.5 years [range 41-84 years]) occurring at a mean of 21 months (range 6-47 months) after surgery. In 1 patient RF occurred twice, with each case at a different time and level, and the symptoms and treatments for these 2 RFs were analyzed separately (1 case of revision surgery and 1 case of nonoperative treatment). The overall rate of RF observed on radiographs after a minimum follow-up of 1 year was 18.0% (54 of 300 cases). The clinical symptoms at the time of RF were pain in 77.8% (42 of 54 cases) and no onset of new symptoms in 20.5% (11 of 54 cases). The pain was temporary and had subsided in 19 of 42 cases (45%) within 2 weeks. In 36 of the 54 cases (66.7%) (including the first RF in the patient with 2 RFs), patients underwent revision surgery at a mean of 116 days (range 5-888 days) after diagnosis. In 18 cases patients received only nonoperative treatment as of the last follow-up, including 17 cases in which the patients experienced no pain and no remarkable progression of deformity (mean 18.5 months after RF development). CONCLUSIONS This analysis of 54 RFs in 53 patients following corrective fusion surgery for ASD demonstrates a relationship between symptoms and alignment change. Revision surgeries were performed in a total of 36 cases. Nonoperative care was offered in 18 (33.3%) of 54 cases at the last follow-up, with no additional symptoms in 17 of the 18 cases. These data offer useful information regarding informed decision making for patients in whom an RF occurs after ASD surgery.

Therapeutic plasma exchange for the treatment of systemic sclerosis: A comprehensive review and analysis.

Background:Therapeutic plasma exchange has been tried as a treatment approach for systemic sclerosis since 1978 based on the rationale that some circulating factor is involved in disease pathogenesis, for example, autoantibodies or immune complexes, and that removing the potential pathogenic factors could lead to symptom improvement. Based on our impression that clinicians and researchers are largely unaware that a large volume of research has been published about the use of therapeutic plasma exchange as a treatment for systemic sclerosis, we conducted a comprehensive review and analysis of all published research on this topic.Results:We identified 46 relevant articles that met our search criteria, involving a total of 572 patients. Of these, 19 were case studies; the rest ranged from small observational studies to prospective randomized clinical trials. In all but two studies, most patients receiving therapeutic plasma exchange showed improvements in both clinical symptoms and laboratory markers, including significant improvement in Raynaud’s symptoms and healing of digital ulceration after three to four weekly treatments. The beneficial effects from even a short course of therapeutic plasma exchange treatments were long-lasting, typically 6 months or longer. Therapeutic plasma exchange was very well tolerated. Adverse events were rare and, in almost all cases, mild and transitory.Conclusion:These results suggest that long-term therapeutic plasma exchange may offer a low-risk way to control and in some cases reverse systemic sclerosis symptoms. The mechanism for the clinical improvements seen from therapeutic plasma exchange in systemic sclerosis patients is unclear. Therefore, additional studies of therapeutic plasma exchange effects in systemic sclerosis appear to be highly desirable.

Chelation and Ozone Combination – the knock-out blow in treating IHD

Abstract: The recent TACT study published in the Journal of the American Medical Association showed that up to 50% of selected patients with heart disease will die from their disease unless they are treated with EDTA chelation therapy. Special benefits are seen in the diabetic population. TACT 2 is now underway to better understand the mechanisms at play to bring about this outcome. (Lamas, G. A., Goertz, C., Boineau, R., Mark, D. B., Rozema, T., Nahin, R. L., et al. (2013). Effect of disodium EDTA chelation regimen on cardiovascular events in patients with previous myocardial infarction: the TACT randomized trial. JAMA, 309(12), 1241–1250.) Now a new study is offering proof that not only can EDTA chelation therapy treat heart disease, it can also treat the atherosclerosis that leads to heart disease. The researchers looked at the effect of EDTA chelation therapy on 118 men and women with atherosclerosis. Their ages ranged from 48 to 89 years old. Before the study began, they measured the pulse wave velocity of their arteries. After only 10 chelation treatments, the pulse wave velocity readings decreased substantially. The arteries were becoming more flexible and less stiff. After 20 chelation treatments, the readings decreased even more. And after 30 treatments, the decrease in the readings seems to have reached their maximum in most of the patients. This is exactly what I have been seeing in my patients for the past 35 years. Maximum effect of chelation therapy tends to occur between 20-30 treatments (Tadashi Mitsuo, MD, Sigenori Nakano, MD, Masao Yoshida,MD, Hideki Ohno,MD, Kazuo Tsubota,MD. Na2EDTA Chelation Therapy Can Decrease baPWV in Elderly Patients. www.acam.org/news. Friday, June 13, 2014 ) When it comes to heart disease, the combination of Chelation and Ozone works even better than the chelation treatments by themselves. The chelation therapy treats the atherosclerosis and the ozone improves the way the heart cells use oxygen – a perfect marriage. Ozone therapy improves oxygen delivery and circulation by: 1 Decreasing the viscosity and thickness of the blood, so that it can navigate the small capillaries better, and is easier to pump 2 Improves the ability of red blood cells to unload oxygen to the tissues. This persists long after the course of treatments is completed 3 Decreases inappropriate inflammation in the blood, allowing for the formation of nitric oxide to help the arteries dilate, further improving blood flow Chelation therapy improves circulation by: 1 Removing heavy metals such as lead, which impair the formation of nitric oxide. Nitric oxide is produced by the lining of the blood vessels as a signal to help arteries relax and dilate, improving circulation Delivering high doses of nutrients such as magnesium, acting as a natural calcium channel blocker to keep arteries dilated and relaxed

Insect sound production and transmission in plant materials of different compositions and structures

Insects use plants for food and shelter, and many species also have taken advantage of plant acoustical and structural characteristics to communicate for mating and social interaction over extended distances without expending significant energy. Humans have taken advantage of plant acoustical and structural characteristics to detect hidden insect infestations passively by monitoring their feeding and movement activities. This presentation reviews the characteristics of sound transmission as well as the characteristics of insect movement and feeding sounds in plant structures and products. Although insect sounds can be masked by loud background noise, different species produce sounds with particular spectral and temporal patterns that help distinguish them from background signals and from each other. Several practical applications of insect bioacoustics are discussed, including disruption of insect mating, targeting of tree pests, and monitoring of the time course of different pest management treatments.

Incidence of venous thromboembolism and use of anticoagulation in hematological malignancies: Critical review of the literature.

Venous Thromboembolism (VTE) frequently complicates the course of hematologic malignancies (HM) and its incidence is similar to that observed in high-risk solid tumors. Despite that, pharmacologic prophylaxis and treatment of VTE in patients with HM is challenging, mainly because a severe thrombocytopenia frequently complicates the course of treatments or may be present since diagnosis, thus increasing the risk of bleeding. Therefore, in this setting, safe and effective methods of VTE prophylaxis and treatment have not been well defined and hematologists generally refer to guidelines produced for cancer patients that give indications on anticoagulation in patients with thrombocytopenia. In this review, besides to summarize the incidence and the available data on prophylaxis and treatment of VTE in HM, we give some advices on how to use antithrombotic drugs in patients with HM according to platelets count.

Dual Epidermal Growth Factor Inhibition and Multi Targeted Epigenetic Therapy (MTET)

Since the discovery of tyrosine kinase inhibitors in treatment of lung cancer harboring such actionable targets, many lives have been prolonged. To the same extent, same group of patients have failed to benefit from this category of drugs, in long run, either initially or during the course of treatments, simply due to either known or unknown mechanism of resistance which occurs very often in the first few months after initiation of therapy. The resistance is 100 percent expected, and no patient is reported to be a waiver of such pattern. With best practices of oncology, the average duration of response is expected to be below 12 months [1]. About half of the resistance is caused by mutation at T790M in EGFR target, which can be revealed by liquid biopsy [1] [2]. The most recent studies have revealed the significant role of epigenome in controlling this complicated resistance pattern. We have learned that Histone deacetylation, as opposed to promoter methylation, may contribute to the epigenetic silencing and to EGFR TKI resistance in NSCLC [3] [4]. Here we present a case study with a model of combinational therapy that targets the EGFR molecule, (by small molecule inhibitor, Afatanib) with simultaneous epigenetic modification of the target, (by application of multitargeted epigenetic therapy (MTET) with significantly improved clinical results. We propose further trials are needed to support such hypothesis, which if proved, could significantly shift the current practices in management of this set of cases in lung adenocarcinomas.

Review of Endometriosis Diagnosis through Advances in Biomedical Engineering

Endometriosis is characterized as the ectopic presence of endometrium in various locations within the abdominal cavity, such as the fallopian tube, the pouch of Douglas, the ovaries, outside the ovaries, and more. The inner lining of the uterus, endometrium, is a dynamic tissue that undergoes morphological and functional changes cyclically. The proliferation of endometrial cells during menstruation is influenced by increasing circulating estrogen levels. Adult progenitor stem cells are likely responsible for this remarkable regenerative capacity and hence, enhanced capacity to generate endometriosis. This chronic estrogen-dependent disease is characterized by the ectopic endometrial implant. The disorder occurs in 6%-10% of reproductive-aged women and in 35%-50% of women with pelvic pain and infertility. Currently, the preferred diagnostic methods are laparoscopic inspection by transvaginal ultrasound, MRI, and sensors. Diagnoses with transvaginal ultrasound have 92.7% sensitivity and 97% specificity in detecting endometriotic lesions. On average, MRI diagnoses of DIE have 74% sensitivity and 95% specificity. Lastly, chemical sensors have 91.7% sensitivity and 90.0% specificity in detecting endometriosis. The standard of care includes personalizing the treatment plan based on the individual's set of symptoms and their severity. Advances in biomedical engineering have aided professionals in personalizing the course of treatments as well as to increasing the quality of life of these patients through various therapies for managing pain. Because no one theory provides a full explanation for the manifestation of the disease, hormonal therapies, targeted therapeutics, and surgical options have emerged as elements of disease management. Clinicians are in the process of developing advanced pharmaceutical drugs with specific orphan target receptors of the ectopic tissue. Possible complications that accompany the condition include dyspareunia, hyperalgesia, infertility, and many others.

Identification of drought-inducible regulatory factors in Lablab purpureus by a comparative genomic approach

Physiological indices of two lines of hyacinth bean (Lablab purpureus (L.) Sweet), MEIDOU 2012 and NANHUI 23, were compared during a progressive course of water-withholding treatments. MEIDOU 2012 was shown to be a superior drought-tolerant genotype. A suppressive subtractive hybridisation library was then constructed by using drought-stressed MEIDOU 2012 roots and sequenced to screen for transcripts with differential abundance variations. In total, 2792 unigenes were assembled from 4064 drought-induced expressed sequence tags. Comparative analysis with other legume genomic sequences, including soybean (Glycine max (L.) Merr.), common bean (Phaseolus vulgaris L.) and lucerne (Medicago sativa L.), was performed, from which 338 unigenes associated with root growth and drought response were identified. Among these unigenes, 27 transcription factors were deduced by functional-domain prediction. The transcription levels of a GRAS and a WRKY transcription factor were confirmed to be responding sensitively to water stresses. Additionally, protein–protein interaction (PPI) networks were predicted for all drought-induced root-related unigenes with different stringency levels. A mitogen-activated protein kinase (MAPK4) and an EF-hand calcium-binding protein (CML24) module were pinpointed to be putative ‘master’ signalling hubs in these PPI networks. Detailed examination of these genomic resources would further reveal key regulators of Lablab drought tolerance.

Revealing the Performance Enhancement of Oxygenated Carbonaceous Materials for Vanadium Redox Flow Batteries: Functional Groups or Specific Surface Area?

AbstractIt is widely recognized that the oxygenated carbonaceous materials improve the performance of vanadium redox flow batteries (VRFBs). However, whether the enhanced vanadium redox reactions are due to the existence of grafted oxygen‐containing functional groups (OCFGs) or the enlarged specific surface areas (SSAs) during the course of surface treatments is still under dispute. To determine which factor is indeed responsible for the enhanced redox reactions, a set amount of OCFGs is intentionally grafted on the model carbon electrode without modifying the surface area using an alkaline‐mediated hydrothermal treatment. Experimental results, using the peak potential separation and the activation energy as electroactivity descriptors in the three‐electrode cell, demonstrate that OCFGs promote the V(II)/V(III) redox reaction, while exhibiting a minute catalytic effect on the V(IV)/V(V) redox reaction. The superior electroactivity is also testified by a flow battery test, in which the energy efficiency as well as the charge/discharge capacity of VRFBs with hydrothermally treated samples is significantly higher than those of VRFBs with the pristine one. Through these experiments, it is verified that OCFGs contribute to the electroactivity promotion for carbon electrodes rather than the enhanced SSA. The findings can guide the effort to design high‐performing carbonaceous electrodes for VRFBs.

Posttherapeutic skeletal muscle mass recovery predicts favorable prognosis in patients with advanced urothelial carcinoma receiving first-line platinum-based chemotherapy

ObjectivesSarcopenia, decreased skeletal muscle mass (SMM), is an adverse prognostic factor in patients with advanced urothelial carcinoma (aUC). Given that SMM is variable depending on disease and patient conditions, changes in SMM over the course of treatments may be also prognostic. We investigated the prognostic role of posttherapeutic SMM recovery (PSR) in patients with aUC receiving first-line platinum-based chemotherapy. Materials and methodsThis retrospective study included 72 consecutive patients with aUC receiving first-line platinum-based chemotherapy. Skeletal muscle index (SMI) was measured on computed tomography images taken before the initiation of and immediately after 2 cycles of chemotherapy. ΔSMI was calculated as [(posttherapeutic SMI − pretherapeutic SMI)/pretherapeutic SMI] × 100, and PSR was defined as ΔSMI >0. Variables associated with progression-free survival (PFS) and overall survival (OS) were evaluated. ResultsDuring the follow-up (median, 18mo for survivors), 60 (83%) patients progressed (2-year PFS, 17%) and 55 (76%) died (2-year OS, 24%). ΔSMI was significantly associated with chemotherapy response (P = 0.012), and was an independent predictor for both PFS (hazard ratio [HR] = 0.94, P<0.001) and OS (HR = 0.93, P<0.001). A total of 15 (21%) patients with PSR demonstrated significantly longer PFS and OS than those without PSR (both P<0.001). On multivariate analysis, PSR was an independent favorable predictor for both PFS (HR = 0.24, P<0.001) and OS (HR = 0.21, P<0.001). Incorporation of PSR into the Bajorin's and Galsky's models improved their c-indices (0.611–0.650, and 0.690–0.708, respectively). ConclusionsPSR is a novel prognostic factor in patients with aUC receiving first-line platinum-based chemotherapy.

Transcutaneous electrical nerve stimulation (TENS) for fibromyalgia in adults.

Background: Fibromyalgia is a long-term medical condition that is characterised by long-lasting widespread pain throughout the body. TENS is a treatment that involves putting pulsed electrical currents across the surface of the skin using two or four electrodes. It is used to manage painful conditions. TENS is inexpensive, can be self-administered by people with fibromyalgia, and is not associated with any particular side effects. TENS reduces pain during movement so it may be useful in addition to other treatments to help people carry on their normal lives. Study characteristics: In January 2017, we found eight clinical studies that examined 315 people. We included TENS administered to produce a non-painful 'tingling' sensation at the site of pain either as a treatment alone or combined with exercise treatment. All studies used TENS in comparison with 'fake' (called placebo or sham) TENS, no treatment, or other treatments such as medicine or hydrotherapy (treatment in water). Key results: We did not find enough high-quality studies to allow us to come to any conclusions about the effectiveness of TENS for fibromyalgia pain. Even though seven studies concluded that TENS relieved pain associated with fibromyalgia, the studies were low quality and the findings for measures of pain were inconsistently reported. Studies did not measure most of our outcomes and it was not always clear what aspects of pain were being reported (e.g. present pain, remembered pain, pain severity, etc.). Only one small pilot study found that one 30-minute treatment of TENS reduced pain on movement during and immediately after treatment; however, there were too few participants observed and it is unknown whether this effect would be maintained over a longer course of TENS treatments. Overall, it is not possible to judge whether TENS reduces pain associated with fibromyalgia. There were no serious side events reported in any of the studies. Quality of the evidence: We rated the quality of the evidence from studies using four levels: very low, low, moderate, or high. Very low-quality evidence means that we are very uncertain about the results. High-quality evidence means that we are very confident in the results. The quality of the evidence was very low overall because of a lack of data.

The cognitive impact of chronic low back pain: Positive effect of multidisciplinary pain therapy

ObjectivesLittle is known about the affected cognitive problems in chronic low back pain patients. For this patient cohort research mostly focused on memory of pain, rather than cognitive difficulties related to pain. Chronic pain may be associated with specific (yet undefined) cognitive deficits that affect everyday behaviour. We set out to compare the cognitive function of patients with chronic low back pain (cLBP) in the course of multidisciplinary pain treatments before and after therapy. MethodsThirty-three patients with cLBP and 25 healthy controls between 20 and 70 years were recruited into the study. The inclusion criteria for patients were: (1) a history of at least 12 weeks of chronic myofascial low back pain without radicular pain sensation before enrolment; (2) grade II and higher chronicity according to von Korff; (3) no opioid medication. The patients recruited had a mean pain duration of 7.13±7.16 years and reported a mean pain intensity of 6.62±2.04 (visual analogue score, VAS). Their mean back function according to the Funktionsfragebogen Hannover (FFbH, a questionnaire comparable with the Health Assessment Questionnaire) was 52.39±20.23%.At three time points (before therapy, 3 weeks and 6 months after therapy) the study subjects were assessed prospectively with a battery of visual memory tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB). These included choice reaction time (CRT), pattern recognition memory (PRM) and spatial span (SSP). In parallel, the Trail-Making Test (TMT-A, TMT-B) and the Wechsler Adult Intelligence Scale (WAIS-III) were used to evaluate intelligence and cognitive flexibility. ResultsAt the beginning of MDPT (T1), it took patients with cLBP significantly longer than HC to complete TMT-A (38.29±19.99s vs 30.25±14.19s, p=0.047) and TMT-B (72.10±26.98s vs 55.99±22.14s, p=0.034). There were no significant differences between patients and HC in CRT, PRM and SSP. Three weeks (T2) and 6 months (T3) after MDPT, TMT-A reaction time of patients significantly improved by 6.5s and 8.1ms (38.3 ±19.9s vs 31.8±12.3s, p=0.02 and 31.8±12.3s vs 30.2±8.9s, p=0.021, respectively). The patients’ working memory was also better 6 months after MDPT (48.8±11.1% at T1, 51.2±11.9% at T2, 57.1±10.9% at T3, p=0.008). Significant correlations among pain, depression/anxiety, medication and neuropsychological tests were found. ConclusionsThese findings show that patients with cLBP have slowed speeds of information processing and working memory, but no alteration in attention and recognition memory. There are clearly interactions of cognitive function with pain, depression, anxiety, and medication. MDPT may improve the impaired cognitive function of patients with cLBP. ImplicationHealth professionals should contemplate the results from this study when planning therapy strategies especially when prescribing pain medications such opioids to patients with chronic low back pain.

Concurrent Electroconvulsive Therapy and Bupropion Treatment.

Bupropion is associated with a dose-dependent increased risk of seizures. Use of concomitant bupropion and electroconvulsive therapy (ECT) remains controversial because of an increased risk of prolonged seizures. This is the first systematic evaluation of the effect of bupropion on ECT. A case group (n = 119), patients treated with concomitant ECT and bupropion, was compared with an age and gender frequency-matched control group (n = 261), treated with only ECT. Electroconvulsive therapy treatment data including seizure length, number of treatments, and concurrent medications were extracted. Longitudinal mixed models examined ECT versus ECT + bupropion group differences over the course of treatments measured by seizure duration (electroencephalogram [EEG] and motor). Multivariable models examined the total number of treatments and first and last seizure duration. All models considered group differences with ECT treatment measures adjusted for age, gender, benzodiazepine treatment, lead placement, and setting. Electroconvulsive therapy treatment with bupropion led to shorter motor seizure duration (0.047) and EEG seizure duration (P = 0.001). The number of ECT treatments (7.3 vs 7.0 treatments; P = 0.23), respectively, or the probability of a prolonged seizure (P = 0.15) was not significantly different. Benzodiazepine use was significantly more common in control subjects (P = 0.01). This is a retrospective analysis limited in part by unavailable variables (seizure threshold, nature of EEG and motor seizure monitoring, type of ECT device, dosing and formulation of bupropion, and duration of the current depressive illness). This study revealed a significantly shorter duration in seizure length with ECT + concomitant bupropion, but not in the number of required treatments in those treated compared with ECT without bupropion. There remains a critical need to reevaluate the efficacy of concomitant use of psychotropic medications + ECT.