CPP Group Research Articles

Growth pattern, growth deceleration, and relevant predictors in girls treated with GnRHa: a retrospective longitudinal study.

This study aimed to analyze the height growth pattern and the incidence of significant growth deceleration in girls with CPP and EFP on GnRHa treatment, and thereby identify relevant predictors of growth deceleration. The data of 99 girls diagnosed with CPP and 47 girls with EFP were included in this retrospective analysis. The incidence of growth deceleration was calculated in both the first and second years. Multivariate logistic regression analysis was used to identify predictors indicative of growth deceleration. Growth velocity (GV) trajectories showed gradual decreases to the nadir at 18months of treatment, and then they recovered till the 24th month of treatment, especially in girls with CPP. Nevertheless, the recovery was significantly greater in the CPP group than EFP. In the first year, no significant difference in the incidence of growth deceleration was found between the CPP group and the EFP group [17.35 vs. 25.53 %, p=0.249]; in the second year, the CPP group had alower incidence than the EFP group [42.86 vs. 76.92 %, p=0.027]. The multivariate logistic regression analysis suggested that bone age (BA) was an independent predictor of growth deceleration (OR=2.264, 95 % CI: 1.268-4.042, p=0.006). The result of ROC curves showed the cut-off value of BA was 11.05 years. GV varies at different periods during GnRHa treatment. GnRHa should be used with more caution for EFPtreatment than for CPP. BA can be used to predict the occurrence of growth deceleration during GnRHa treatment.

Vaginal and rectal microbiome contribute to genital inflammation in chronic pelvic pain

BackgroundChronic pelvic pain (CPP) is a multifactorial syndrome that can substantially affect a patient’s quality of life. Endometriosis is one cause of CPP, and alterations of the immune and microbiome profiles have been observed in patients with endometriosis. The objective of this pilot study was to investigate differences in the vaginal and gastrointestinal microbiomes and cervicovaginal immune microenvironment in patients with CPP and endometriosis diagnosis compared to those with CPP without endometriosis and no CPP.MethodsVaginal swabs, rectal swabs, and cervicovaginal lavages (CVL) were collected among individuals undergoing gynecologic laparoscopy. Participants were grouped based on patients seeking care for chronic pain and/or pathology results: CPP and endometriosis (CPP-Endo) (n = 35), CPP without endometriosis (n = 23), or patients without CPP or endometriosis (controls) (n = 15). Sensitivity analyses were performed on CPP with endometriosis location, stage, and co-occurring gynecologic conditions (abnormal uterine bleeding, fibroids). 16S rRNA sequencing was performed to profile the microbiome, and a panel of soluble immune mediators was quantified using a multiplex assay. Statistical analysis was conducted with SAS, R, MicrobiomeAnalyst, MetaboAnalyst, and QIIME 2.ResultsSignificant differences were observed between participants with CPP alone, CPP-Endo, and surgical controls for body mass index, ethnicity, diagnosis of ovarian cysts, and diagnosis of fibroids. In rectal microbiome analysis, both CPP alone and CPP-Endo exhibited lower alpha diversity than controls, and both CPP groups revealed enrichment of irritable bowel syndrome-associated bacteria. CPP-Endo exhibited an increased abundance of vaginal Streptococcus anginosus and rectal Ruminococcus. Patients with CPP and endometrioma (s) demonstrated increased vaginal Streptococcus, Lactobacillus, and Prevotella compared to other endometriosis sites. Further, abnormal uterine bleeding was associated with an increased abundance of bacterial vaginosis-associated bacteria. Immunoproteomic profiles were distinctly clustered by CPP alone and CPP-Endo compared to controls. CPP-Endo was enriched in TNF⍺, MDC, and IL-1⍺.ConclusionsVaginal and rectal microbiomes were observed to differ between patients with CPP alone and CPP with endometriosis, which may be useful in personalized treatment for individuals with CPP and endometriosis from those with other causes of CPP. Further investigation is warranted in patients with additional co-occurring conditions, such as AUB/fibroids, which add additional complexity to these conditions and reveal the enrichment of distinct pathogenic bacteria in both mucosal sites. This study provides foundational microbiome-immunoproteomic knowledge related to chronic pelvic pain, endometriosis, and co-occurring gynecologic conditions that can help improve the treatment of patients seeking care for pain.

Analysis of serum insulin-like growth factor-1, fibroblast growth factor 23, and Klotho levels in girls with rapidly progressive central precocious puberty

To study the levels of serum insulin-like growth factor 1 (IGF-1), fibroblast growth factor 23 (FGF23), and Klotho, and to study their relationship with girls with rapidly progressive central precocious puberty (RP-CPP). This is a cross-sectional study on the progression rate of central precocious puberty in girls, who complained of breast development before the age of 8 years and were followed between June 2021 and June 2022. At the same time, 28 healthy girls less than 8 years old who had not started puberty were recruited as the control group. The physical examination and laboratory evaluation of each group was completed. Only patients with CPP received pelvic ultrasound examination and bone age test. Bone age index (BAI), basal LH levels (BLH), basal LH levels/basal FSH levels (BFSH), peak LH (PLH)/peak FSH (PFSH), IGF-1, Klotho, FGF23, and ovarian volume in the RP-CPP group were higher than those in slowly progressive CPP (SP-CPP) group. In the RP-CPP group, IGF-1 was correlated with Klotho, FGF23, and BLH; Klotho was correlated with FGF23 and BLH; FGF23 was correlated with BLH.Conclusion: The BLH, FGF23, Klotho, and IGF-1 have a certain correlation with RP-CPP, which may play an important role in the speed of girls’ sexual development.What is Known:• The association between IGF-1 and RP-CPP.What is New:• We found the association between FGF23, Klotho and RP-CPP.

Effect of Different Desensitizing Protocols on Pulp Inflammatory Responses in Whitened Teeth: A Randomized Clinical Trial

Purpose: This randomized controlled, blind clinical trial evaluated the efficacy of different desensitizing protocols in preventing pulp inflammation after whitening treatment with hydrogen peroxide (HP) at 35% (Whiteness HP 35%). Materials and Methods: Thirty healthy third human molars extracted by orthodontic indication were randomized and allocated into five groups (n=5): NC (negative control): without intervention; PC (positive control): HP; PBM: HP + photobiomodulation with a Watts LASER; CPP: HP + casein phosphopeptide amorphous calcium phosphopeptide (CPP-ACP); and NANO: HP + nano-hydroxyapatite. The in-office whitening was performed in two sessions with a single 45 minutes application at an interval of 48 hours. Pulp tissues were extirpated for immunohistochemical analysis. Immunoreaction for activated caspase-3 was observed, and images were acquired using an Axio Scope A1 microscope. The Kruskal-Wallis test was used to evaluate the immunoexpression of caspase-3. Results: Comparisons between the PC and NC groups revealed a statistically significant difference (p<0.05) for the analysis of caspase-3 immunoexpression. A statistically significant difference (p<0.05) was also observed for the CPP and PBM groups in relation to the PC. Conclusion: Photobiomodulation and CPP-ACP are promising alternatives to minimize pulpal inflammation induced by tooth whitening. Clinical Trial Registration Number: NCT04548674.

Neural correlates of cocaine-induced conditioned place preference in the posterior cerebellar cortex.

Addictive drugs are potent neuropharmacological agents capable of inducing long-lasting changes in learning and memory neurocircuitry. With repeated use, contexts and cues associated with consumption can acquire motivational and reinforcing properties of abused drugs, triggering drug craving and relapse. Neuroplasticity underlying drug-induced memories takes place in prefrontal-limbic-striatal networks. Recent evidence suggests that the cerebellum is also involved in the circuitry responsible for drug-induced conditioning. In rodents, preference for cocaine-associated olfactory cues has been shown to correlate with increased activity at the apical part of the granular cell layer in the posterior vermis (lobules VIII and IX). It is important to determine if the cerebellum's role in drug conditioning is a general phenomenon or is limited to a particular sensory modality. The present study evaluated the role of the posterior cerebellum (lobules VIII and IX), together with the medial prefrontal cortex (mPFC), ventral tegmental area (VTA), and nucleus accumbens (NAc) using a cocaine-induced conditioned place preference procedure with tactile cues. Cocaine CPP was tested using ascending (3, 6, 12, and 24 mg/kg) doses of cocaine in mice. Compared to control groups (Unpaired and Saline animals), Paired mice were able to show a preference for the cues associated with cocaine. Increased activation (cFos expression) of the posterior cerebellum was found in cocaine CPP groups and showed a positive correlation with CPP levels. Such increases in cFos activity in the posterior cerebellum significantly correlated with cFos expression in the mPFC. Our data suggest that the dorsal region of the cerebellum could be an important part of the network that mediates cocaine-conditioned behavior.

Occult hepatitis C infection identified in injection drug users with direct antiviral agents therapy and spontaneous resolution of hepatitis C virus infection

BackgroundOccult hepatitis C infection (OCI) is characterized by the detection of hepatitis C virus (HCV) RNA in hepatocytes and in peripheral blood mononuclear cells (PBMCs) without detection in serum. We aimed to evaluate OCI in drug and no drug users who achieved sustained virological response (SVR) after therapy with direct-acting antivirals (DAAs) and with HCV spontaneous resolution. MethodsTwenty-four patients in the AVP group (who achieved a SVR after DAAs therapy), 13 in the NAVP group (with HCV spontaneous resolution) and 7 HCV-RNA positive patients (CPP, control positive group) were included in the study. HCV/OCI-RNA was screened in serum and PBMCs samples of the patients by ddPCR for OCI patients’ identification. Plasma and red blood cells (RBCs) samples of the patients were also evaluated for HCV/OCI-RNA detection by ddPCR. ResultsOCI was presented in injection drug users (IDUs) in the AVP (20.8%) and NAVP (23.1%) groups by ddPCR with a higher statistically significant percentage detected in RBCs samples of the patients in the AVP group comparatively to NAVP (p<0.01) and CPP (p < 0.05) groups. ConclusionOCI was identified in IDUs patients of the AVP and NAVP groups by ddPCR. These results suggest that OCI patients in the AVP group might not be entirely cured, and that OCI patients in the NAVP group were not identified at clinical evaluation time when just serum samples were analysed. A higher percentage of HCV/OCI-RNA was detected in RBCs samples. Overall results recommends that HCV/OCI identification in patients with DAAs therapy and spontaneous resolution of HCV infection should be studied more accurately in future and in larger patient groups if possible. Additionally, suggest also PBMCs and RBCs samples as predictors for HCV/OCI diagnosis and management.

Frequency-dependent alterations in regional homogeneity associated with puberty hormones in girls with central precocious puberty: A resting-state fMRI study

ObjectiveCentral precocious puberty (CPP) patients are at significantly higher risk of emotional, mental, and behavioral disorders than those normal pubertal population. However, to date, the definite mechanism of how puberty hormones affect patients with CPP remains unclear. This regional homogeneity (ReHo) study aimed to explore the impact of premature hypothalamus-pituitary-gonadal (HPG) axis activation on brain function alteration in girls with CPP, meanwhile, to explore the relationship between gonadotropin and gonadal hormones levels, abnormal brain activity and cognitive function. MethodsIn this prospective study, a total of 85 girls who were suspected of having CPP were enrolled from the Child Healthcare Department of the Second Affiliated Hospital of Wenzhou Medical University Hospital from June 2018 to May 2021, including 41 CPP girls and 44 non-CPP girls. All participants collected the 0, 30, 60 min blood luteinizing hormone (LH), follicle-stimulating hormone (FSH), 0, 30 min estradiol (E2) and baseline cortisol (COR) and prolactin (PRL) concentrations after gonadotrophin-releasing hormone (GnRH) stimulating test. Resting-state magnetic resonance imaging (rs-MRI) scans were performed for all participants at 2 weeks before the GnRH stimulating test, voxel-wise ReHo was calculated in the standard frequency band (0.01–0.10 Hz), and in slow-4 (0.027–0.073 Hz) and slow-5 (0.01–0.027 Hz). Wechsler Intelligence Scale for Children Fourth Edition (WISC-IV) was also collected. Independent-sample t-test or Mann-Whitney U test was used to compare the differences between two groups. The correlation analysis among abnormal brain regions, serum hormone levels and WISC-IV scores were performed by Spearman or partial correlation analysis. ResultsCompared to the non-CPP group, the CPP group showed higher regional homogeneity (ReHo) values in the left inferior temporal gyrus (ITG.L), as well as lower ReHo values in left superior temporal gyrus (STG.L), left superior occipital gyrus (SOG.L) and the right middle gyrus (MTG.R) in slow4.in slow5 frequency band, CPP group demonstrated decreased ReHo values in bilateral orbital part of superior frontal gyrus and medial superior frontal gyrus. LimitationDue to the cross-section design of this study, further research is needed to explore the relationships between age, premature activation HPG axis and brain function changes. ConclusionOur findings demonstrate that premature HPG axis activation and alterations in puberty hormones, may lead to changes in brain activity and cognitive function. This rs-fMRI study may enhance our understanding of the neuroendocrine mechanisms of mood, behavior, and cognitive function alterations in patients with CPP.

Vitamin D status and parathyroid hormone assessment in girls with central precocious puberty

PurposeThe objective of this study was to analyze vitamin D status and PTH concentrations in 6- to 8-year-old girls with central precocious puberty.MethodsA cross-sectional clinical and blood testing study (calcium, phosphorus, 25(OH)D and PTH) was carried out in 78 girls with central precocious puberty (CPP group), aged 6.1–7.9 years. A control group was recruited (137 prepubertal girls, aged 6.1–8.2 years). The criteria of the US Endocrine Society were used for the definition of hypovitaminosis D.ResultsThere were no significant differences in vitamin D status between both groups. There were no significant differences in 25(OH)D concentrations between CPP (25.4 ± 8.6 ng/mL) and control groups (28.2 ± 7.4 ng/mL). In contrast, PHT concentrations in CPP group (44.8 ± 16.3 pg/mL) were higher (p < 0.05) with respect to control group (31.0 ± 11.9 ng/mL). In CPP group, there was a positive correlation (p < 0.05) between PTH concentrations and growth rate, bone age, and basal estradiol, basal FSH, basal LH and LH peak concentrations.ConclusionVitamin D status in 6- to 8-year-old girls with CPP is similar to that in prepubertal girls. PTH concentrations were significantly higher in girls with CPP, and this could be considered as a physiological characteristic of puberty and, in this case, of pubertal precocity.

Hypogastric Artery Flow Interruption is Associated with Increased Mortality After Open Aortic Repair

Potential complications of pelvic flow disruption during aortic aneurysm repair include buttock ischemia and mesenteric ischemia. Unilateral or bilateral hypogastric artery flow interruption, either from atherosclerosis or intentionally to facilitate aneurysm repair, is considered problematic in endovascular repair; however, it has not been well studied in open abdominal aortic aneurysm (AAA) repair (OAR). We sought to examine the effect of interruption of flow to one or both hypogastric arteries on outcomes after OAR. The Society for Vascular Surgery Quality Initiative database was queried for all patients undergoing elective open AAA repair between 2003 and 2020. (redundant) Patients with appropriate data on their hypogastric arteries postoperatively were stratified into two groups-patent bilaterally (normal pelvic perfusion, NPP) and unilateral or bilateral occlusion or ligation (compromised pelvic perfusion, CPP). Primary endpoints were 30-day major morbidity (myocardial infarction, respiratory complications, renal injury, and lower extremity or intestinal ischemia) and mortality. During the study period, 9.492 patients underwent elective open AAA repair-860 (9.1%) with compromised pelvic perfusion and 8,632 (90.9%) with patent bilateral hypogastric arteries. The groups had similar cardiac risk factors, including a history of coronary artery disease, prior coronary intervention, and the use of P2Y12 inhibitors and statins. A majority of patients in the CPP cohort had concurrent iliac aneurysms (63.3% vs. 24.8%; P<0.001). The perioperative mortality was significantly higher in patients with compromised pelvic perfusion (5.5% vs. 3.1%; P<0.001). Bilateral flow interruption had a trend toward higher perioperative mortality compared to unilateral interruption (7.1% vs. 4.7%; P<0.147). The CPP group also had increased rates of myocardial injury (6.7% vs. 4.7%; P=0.012), renal complications (18.9% vs. 15.9%; P=0.024), leg and bowel ischemia (3.5% vs. 2.1%; P=0.008; and 5.7% vs. 3.4%; P<0.001, respectively). On multivariable analysis, CPP was associated with increased perioperative mortality (OR 1.47, CI 1.14-1.88, P=0.003). On Kaplan-Meier analysis, there was no difference in survival at 2years postdischarge between the NPP and CPP cohorts (86.1% vs. 87.5%, log-rank P=0.275). Compromised pelvic perfusion is associated with increased perioperative complications and higher mortality in patients undergoing OAR. The sequelae of losing pelvic perfusion, in addition to the presence of more complex atherosclerotic and aneurysmal disease resulting in more difficult dissection, likely contribute to these findings. Thus, patients considered for OAR who have occluded hypogastric arteries or aneurysmal involvement of the hypogastric artery preoperatively may be candidates for more conservative management beyond traditional size criteria.

Hypogastric Artery Flow Interruption Is Associated With Increased Mortality After Open Aortic Repair

INTRODUCTION The two feared complications of pelvic flow disruption include buttock and mesenteric ischemia. Unilateral or bilateral hypogastric artery flow interruption, either from atherosclerosis or intentionally, is not well studied in open AAA repair (OAR). METHODS The Society for Vascular Surgery Quality Initiative database was queried for all patients undergoing elective open AAA repair between 2003 and 2020. Patients with data on their hypogastric arteries were stratified into two groups - patent bilaterally (normal pelvic perfusion, NPP), and unilateral or bilateral occlusion or ligation (compromised pelvic perfusion, CPP). Primary endpoints were 30-day major morbidity and mortality. RESULTS During the study period, 9.492 patients underwent elective open AAA repair - 860 (9.1%) with compromised pelvic perfusion and 8,632 (90.9%) with patent bilateral hypogastric arteries. The groups had similar cardiac risk factors (Table 1). A majority of patients in the CPP cohort had concurrent iliac aneurysms (63.3% versus 24.8%; p<.001). The perioperative mortality was significantly higher in patients with compromised pelvic perfusion (5.5% versus 3.1%; p<.001). Bilateral interruption had a higher perioperative mortality compared to unilateral interruption (7.1% versus 4.7%; p<001). The CPP group had increased rates of myocardial injury (6.7% versus 4.7%; p=.012), leg and bowel ischemia (3.5% versus 2.1%, p=.008; and 5.7% versus 3.4%, p<.001; respectively). On multivariable analysis, CPP was associated with increased mortality (OR 1.47, CI 1.14-1.88, p=.003). However, on Kaplan-Meier analysis, there was no difference on long-term survival. CONCLUSIONS CPP is associated with increased perioperative complications and higher mortality in patients undergoing OAR, with no affect on longer-term survival. Hypogastric artery occlusion or need for ligating these vessels likely signifies presence of more complex disease, and warrants careful technique and appropriate patient selection. The two feared complications of pelvic flow disruption include buttock and mesenteric ischemia. Unilateral or bilateral hypogastric artery flow interruption, either from atherosclerosis or intentionally, is not well studied in open AAA repair (OAR). The Society for Vascular Surgery Quality Initiative database was queried for all patients undergoing elective open AAA repair between 2003 and 2020. Patients with data on their hypogastric arteries were stratified into two groups - patent bilaterally (normal pelvic perfusion, NPP), and unilateral or bilateral occlusion or ligation (compromised pelvic perfusion, CPP). Primary endpoints were 30-day major morbidity and mortality. During the study period, 9.492 patients underwent elective open AAA repair - 860 (9.1%) with compromised pelvic perfusion and 8,632 (90.9%) with patent bilateral hypogastric arteries. The groups had similar cardiac risk factors (Table 1). A majority of patients in the CPP cohort had concurrent iliac aneurysms (63.3% versus 24.8%; p<.001). The perioperative mortality was significantly higher in patients with compromised pelvic perfusion (5.5% versus 3.1%; p<.001). Bilateral interruption had a higher perioperative mortality compared to unilateral interruption (7.1% versus 4.7%; p<001). The CPP group had increased rates of myocardial injury (6.7% versus 4.7%; p=.012), leg and bowel ischemia (3.5% versus 2.1%, p=.008; and 5.7% versus 3.4%, p<.001; respectively). On multivariable analysis, CPP was associated with increased mortality (OR 1.47, CI 1.14-1.88, p=.003). However, on Kaplan-Meier analysis, there was no difference on long-term survival. CPP is associated with increased perioperative complications and higher mortality in patients undergoing OAR, with no affect on longer-term survival. Hypogastric artery occlusion or need for ligating these vessels likely signifies presence of more complex disease, and warrants careful technique and appropriate patient selection.

The Immunomodulatory Effects of Phellodendri Cortex Polysaccharides on Cyclophosphamide-Induced Immunosuppression in Mice.

Cyclophosphamide is a commonly used anticancer drug, and immunosuppression is one of the most common side effects. How to recover the immunological function is important for cyclophosphamide-treated patients. In the present study, Phellodendri Cortex polysaccharides (CPP) could enhance the proliferation of mouse spleen lymphocytes in vitro. The immunoregulatory function of CPP was then investigated in cyclophosphamide-induced immunosuppressed mice. In CPP-treated groups, mice were orally treated with CPP at doses of 1, 0.5, and 0.25 g/kg bodyweight from 1 to 11 d, respectively. The cyclophosphamide was administrated in CPP and cyclophosphamide groups from 12 to 14 d. In the cyclophosphamide and normal control groups, the mice received equal volume of saline from 1 to 14 d. The results showed that CPP (1 g/kg) could significantly increase the bodyweight of mice, even during cyclophosphamide treatment. The organ coefficients of the spleen and thymus were recovered by CPP treatment. CPP upregulated the contents of cytokines (IL-2, IL-6, IFN-γ, and TNF-α) in serum, which were downregulated by cyclophosphamide. The mRNA levels of these cytokines were also elevated by CPP treatment in the spleen. Cyclophosphamide upregulated the expressions of NF-κB p65, TLR4, and MyD88, suggesting that the NF-κB signaling pathway was activated by cyclophosphamide. After CPP treatment, it was recovered to normal level. These results indicated that CPP alleviated the cyclophosphamide-induced immunosuppression.

Kisspeptin Levels in Girls with Precocious Puberty: A Systematic Review and Meta-Analysis

Background/Aims: Kisspeptin (KP) is a key player in the regulation of the release of gonadotropin-releasing hormone (GnRH), which increases the secretion of gonadotropin during puberty to establish reproductive function and regulate the hypothalamic-pituitary-gonadal axis. Premature activation of GnRH secretion leads to idiopathic/central gonadotropin-dependent precocious puberty (CPP). We aimed to compare the blood KP concentrations in girls with CPP and healthy controls. Methods: A systematic review and meta-analysis was performed. We searched MEDLINE, EMBASE, The Cochrane Library, and SciELO. Random-effects model and standardized mean difference (SMD) were used. Heterogeneity was assessed through I². Meta-regression considered patient age, KP fraction, and analytical method for KP measurement. Results: The 11 studies included comprised 316 CPP patients and 251 controls. Higher KP levels in the CPP group were found (SMD 1.53; CI 95% = 0.56–2.51). Subgroup analysis revealed association with patient age (p = 0.048), indicating a positive correlation between elevation in KP concentration and age in CPP group. A group of patients with precocious thelarche (PT) from 5 of the included studies comprising 121 patients showed higher levels of KP (1.10; −0.25–2.45: CI 95%) and high heterogeneity (I² = 91%). The CPP/PT ratio for KP level indicates KP 36% higher on CPP than PT patients. Conclusions: A consistent difference in KP levels between girls with CPP and controls was identified. While there are important limitations in KP assays which argue against its use as a diagnostic tool, the KP levels in CPP versus control and PT children are consistent with the predicted mechanisms and pathophysiology of CPP.

Pain Induced Changes in Brain Oxyhemoglobin: A Systematic Review and Meta-Analysis of Functional NIRS Studies.

Neuroimaging studies show that nociceptive stimuli elicit responses in an extensive cortical network. Functional near-infrared spectroscopy (fNIRS) allows for functional assessment of changes in oxyhemoglobin (HbO), an indirect index for cortical activity. Unlike functional magnetic resonance imaging (fMRI), fNIRS is portable, relatively inexpensive, and allows subjects greater function. No systematic review or meta-analysis has drawn together the data from existing literature of fNIRS studies on the effects of experimental pain on oxyhemoglobin changes in the superficial areas of the brain. To investigate the effects of experimental pain on brain fNIRS measures in the prefrontal-cortex and the sensory-motor-area; to determine whether there is a difference in oxyhemodynamics between the prefrontal-cortex and sensory-motor-area during pain processing; to determine if there are differences in HbO between patients with centralized persistent pain and healthy controls. Studies that used fNIRS to record changes in oxyhemodynamics in prefrontal-cortex or sensory-motor-cortex in noxious and innoxious conditions were included. In total, 13 studies were included in the meta-analysis. Pain has a significantly greater effect on pre-frontal-cortex and sensory-motor areas than nonpainful stimulation on oxyhemodynamics. The effect of pain on sensory-motor areas was greater than the effect of pain on the prefrontal-cortex. There was an effect of centralized pain in the CPP group on oxyhemodynamics from a noxious stimulus compared to control's response to pain. Pain affects the prefrontal and sensory-motor cortices of the brain and can be measured using fNIRS. Implications of this study may lead to a simple and readily accessible objective measure of pain.

Comparison of Continuous Hypothermic Oxygenated Crystalloid Perfusion with the Novel Solution “Custodiol N ” and Warm Blood Perfusion in a Porcine DCD Donation Model

Transplantation programs are worldwide burdened by the limited availability of suitable donor hearts, despite extending the donation criteria. Organ donation after circulatory death (DCD) became a reliable alternative over the past few years. Nevertheless, the grafts fetched as DCDs are submitted to a further ischemic insult due to the progressive hypoxia and circulatory arrest occurring between withdrawal of care and declaration of death. Although diverse storage and perfusion strategies exist to preserve DCD hearts, no direct comparison has yet been performed. The aim of the present study is to examine the effects of a novel cold crystalloid preservation solution (Custodiol-N) and warm blood perfusion protocols compared to simple cold storage in a porcine model. In 39 pigs, DCD was induced by asphyxia and the hearts underwent 30 min initial warm ischemia in the donor. The hearts were than explanted and divided in 4 groups: 1) control group (n=8) was placed directly in a Langendorff model. In group 2 (CSG, n=8) the hearts were flushed with 2L of 4°C Custodiol N solution and then stored in the same solution for 4h before evaluation. In group 3 (CCP, n=8), the hearts underwent a 4h continuous oxygenated 4°C cold machine perfusion cycle with Custodiol N. In group 4 (WBP, n=7) the hearts were placed on warm blood reperfusion for 4h. Left ventricular function was defined by dP/dt min & max at different ventricle filling volumes. Coronary blood flow (CBF) was measured at 100 mmHg perfusion pressure and Troponin T was collected up to 2 hours. Both dP/dt min & max were significantly higher in the CPP group compared to the WBP group [-1038±182 vs -344±38 mmHg/s; p=0.0356 and 1441±194 vs 498±53 mmHg/s; p=0.0123 respectively]. CBF was also significantly higher in the CCP group [1145±57vs 726±72ml/min; p=0.0032]. Moreover, Troponin T was significantly elevated in the WBP compared to the CCP group [27477±11777 vs 251034±90247 pg/ml, p=0.0239]. There were no significant differences among the WBP, CSG and control groups. Continuous hypothermic oxygenated crystalloid perfusion with the novel preservation solution Custodiol N offers superior preservation and resuscitation of DCD hearts in terms of functional recovery and myocardial enzyme release.

Mid-term predictive value of calciprotein particles in maintenance hemodialysis patients based on a gel-filtration assay

Background and aimsCalciprotein particles (CPPs), nano-aggregates containing fetuin-A-bound calcium-phosphate, are associated with aortic stiffness and coronary calcification in maintenance hemodialysis patients. A novel gel-filtration assay can detect low-density small CPPs, which are actually a major form of circulating CPPs in vivo. We sought to investigate whether circulating CPP levels measured by gel-filtration method would accurately predict hard endpoints in maintenance hemodialysis patients. MethodsThis study used a prospective, multicenter, longitudinal, and observational design. One-hundred eight patients enrolled in this study were followed-up for about 2 years. We reported all-cause death and cardiovascular events, which included major adverse cardiac, cerebrovascular, and limb events. ResultsKaplan-Meier analysis showed no significant difference between patients with the higher (>median) and lower (<median) CPP levels with regard to all-cause death. However, the higher CPP group showed a higher incidence of cardiovascular events (log-rank test χ2 = 4.41, p = 0.036). Univariate Cox regression analysis revealed that CPP levels were not associated with all-cause death, but were significantly associated with higher incidence of cardiovascular events (hazard ratio (HR) 1.03, 95% confidence interval (CI) [1.02–1.05], p < 0.001) for every thousand CPP increase. Multivariate Cox regression analysis revealed that CPP levels were not associated with all-cause death, but were independently associated with cardiovascular events (HR 1.03, 95% CI [1.01–1.04], p < 0.001) for every thousand CPP. ConclusionsThis finding suggests a potential predictive value of CPPs in maintenance hemodialysis patients.

Validation of an Accurate and Noninvasive Tool to Exclude Female Precocious Puberty: Pelvic Ultrasound With Uterine Artery Pulsatility Index.

OBJECTIVE. The purpose of this study is to validate the accuracy of pelvic ultrasound (US) with the evaluation of uterine artery pulsatility index (PI) to exclude female precocious puberty. MATERIALS AND METHODS. Tanner breast development score, luteinizing hormone (LH) peak after gonadotropin-releasing hormone (GnRH) stimulation, and uterine and ovarian volumes and diameters were assessed with pelvic US in 495 girls at a single institution. The study population was divided as follows: prepubertal (n = 207), pubertal with physiologic activation of the hypothalamic-pituitary-ovarian axis (n = 176), and central precocious puberty (CPP; n = 112). PI was measured with spectral Doppler US at the ascending branches of the right uterine artery (50-Hz filter; time gain compensation, 73; pulse repetition frequency, 6.6). ROC analyses and t tests were performed. RESULTS. The mean (± SD) PI values in the prepubertal, pubertal, and CPP groups were 6.3 ± 1.4, 3.4 ± 1.1, and 4.1 ± 1.5, respectively (p < 0.001). The best PI cutoff value to distinguish pubertal from prepubertal girls was 4.6 (sensitivity, 83%; specificity, 94%; positive predictive value, 95%; negative predictive value, 80%; accuracy, 87%). ROC AUC values for LH peak (cutoff value, 5 mU/mL) and for spectral Doppler US PI plus longitudinal uterine diameter (i.e., the combination of a PI of 4.6 with a longitudinal uterine diameter of 35 mm) were 0.9272 and 0.9439, respectively (p = 0.7925). The negative predictive values for LH peak and for PI plus longitudinal uterine diameter were 89% and 88%, respectively. CONCLUSION. A PI greater than 4.6 at spectral Doppler US combined with a longitudinal uterine diameter less than 35 mm allows noninvasive exclusion of female precocious puberty with comparable accuracy and lower costs compared to examination of LH peak after GnRH stimulation. Therefore, PI plus longitudinal uterine diameter might be used as a noninvasive first-line test to exclude precocious puberty and thereby avoid further investigations.

The Association Between Posttraumatic Negative Self-Conscious Cognitions and Emotions and Maladaptive Behaviors: Does Time Since Trauma Exposure Matter?

Negative beliefs about the self, self-blame, guilt, and shame have been consistently linked to emotional problems, such as posttraumatic stress disorder and depression, following trauma exposure. To expand understanding of the potential role of negative self-conscious cognitions and emotions in other forms of posttrauma maladjustments, such as maladaptive behaviors, the current study examined the associations between these cognitions and emotions with dissociation, alcohol use, and avoidant problem-solving. As a secondary goal, the influence of time since trauma exposure was considered given recent data suggesting that some posttraumatic responses require lengthier time following trauma to become salient. Multiple-group analysis was conducted in two groups of female survivors of intimate partner violence (IPV): women whose IPV experiences occurred within 3 months prior to assessment (early posttrauma phase [EPP]; n = 67) and those whose experiences occurred 12 months or more prior to assessment (chronic posttrauma phase [CPP]; n = 145). The results suggested model invariance. Posttraumatic negative self-conscious cognitions and emotions were significantly correlated with dissociation (EPP group: β = .61, p < .001 and CPP group: β = .48, p < .001), alcohol use (EPP group: β = .31, p = .014 and CPP group: β = .30, p < .001), and avoidant problem-solving (EPP group: β = .58, p < .001 and CPP group: β = .56, p < .001). The findings highlight the importance of negative self-conscious cognitions and emotions in posttrauma maladjustment and support intervening in these domains shortly after trauma exposure.

Effects of Dietary FOS and CPP on growth performance and serum biochemical parameters for weaned piglets

The present experiment was conducted to study the effects of different levels of oligosaccharide(FOS) and complex CPP preparation(CPP) in diets on growth performance and serum biochemical parameters for weaned piglets. 240 crossbred DLY( Duroc× Landrace× Yorkshire) 21-day-old weaning piglets, about 7.2 kg in initial body weight were selected and randomly divided into 6 groups, with 2 repeats for each group, 20 each repeat(half male and half female.). Group 1, as the control group, was fed base diet(BD), group 2 was fed BD adding 0.10% aureomycin, group 3, 4, 5, 6, respectively, was fed BD adding 0.05% CPP, 0.05% FOS, 0.20% FOS and 0.10% FOS + 0.05% of CPP. Feeding trial was conducted for 35 days. Results: (1) The combination of 0.10%FOS and 0.05%CPP(group 6) were added, the average daily gain of weaned pigs increased by 13.71 % (P &lt; 0.05) and the feed conversion ratio was reduced by 7.41 % (P &lt; 0.05) compared with control. The diarrhea rate of piglets decreased by 94.63 % (P &lt; 0.01) compared with the control (p &lt; 0.05), and decreased by 62.86 % (P &lt;0.05) compared with group 2.(2)There was no significant difference in the apparent digestibility of nutrient, such as ether extract and crude protein, by adding FOS and CPP individually or jointly in diet of weaned piglets, but apparent digestibility of crude fiber increased , to acertain extent, and there was no significant difference with diet adding 0.10 % of antibiotics (group 2)(P &gt;0.05).(3) There was no significant difference in serum biochemical indexes, such as serum total protein, albumin, urea nitrogen, cholesterol, triglycerides, alanine aminotransferase, aspartate aminotransferase and sugar by adding FOS and CPP individually or jointly in diet of weaned piglets (P &gt; 0.05);there was no significant effect in serum immunoglobulin IgG and IgM (P&gt; 0.05), but the serum IgE content was increased in different degrees. Conclusion: Adding FOS and CPP in diet for weaned piglets can improve the growth performance, reduce diarrhea rate of piglets, and promote digestion and absorption of feed nutrients, without significant difference between them and diet adding antibiotics. Among them, the effect of adding 0.10%FOS+0.05%CPP was the best.

Insulin Sensitivity and Clinical Profiles in CPP Girls Compared to Controls

Objective: This study aimed to compare obesity, insulin sensitivity, clinical, and metabolic parameters between CPP and age-matched control girls, with or without obese girls and to determine correlations between these factors. Methods: CPP and control girls were recruited and were allocated into obese and non-obese groups. There were 3 groups of comparison including non-obese control girls (n=29), non-obese CPP girls (n=20), and obese CPP girls (n=6), because obese controls could not be recruited. Results: Body mass index (BMI), body weight, and height percentiles were higher in obese CPP and non-obese CPP girls compared to control girls. Lipid profiles, glucose, insulin, the homeostasis model assessment-estimated insulin resistance (HOMA-IR), and the quantitative insulin sensitivity check index (QUICKI) were not different between all groups. Insulin and the HOMA-IR were positively but the QUICKI was negatively correlated with metabolic and anthropometric parameters mainly in the control group, while these parameters were significantly correlated with LH and FSH in the CPP group. From multivariate regression, insulin and the HOMA-IR were associated with reproductive indices in CPP and with fat mass in controls. Conclusion: Insulin sensitivity and insulin resistance were related to metabolic factors in prepubertal stage, but were more associated with the reproductive status during pubertal advancement.

Randomized clinical trial of the effect of NovaMin and CPP-ACPF in combination with dental bleaching

Objective This randomized, controlled, double-blind clinical study evaluated the effect of calcium sodium phosphosilicate (NovaMin) and casein phosphopeptide-amorphous calcium phosphate with fluoride (CPP-ACPF) on the prevention of post-operative sensitivity and on the effects of clinical bleaching treatment.Material and Methods Sixty volunteers were selected according to inclusion and exclusion criteria and were randomly assigned into three groups (n=20): CG (control group) patients, who were treated with 35% hydrogen peroxide; NOVAG (NovaMin group) patients, who were treated with 35% hydrogen peroxide followed by the application of NovaMin; and CPPG (CPP group) patients, who were treated with 35% hydrogen peroxide followed by the application of CPP-ACPF. Both bioactive agents were applied for five minutes. An evaporative stimulus associated with a modified visual scale was used to analyze sensitivity 24 hours after each bleaching session. The color evaluation was performed on the maxillary central incisors using a spectrophotometer. Associations between the intervention group, bleaching session, and reported sensitivity were tested using Chi-square partitioning.Results Color change values (ΔE) were analyzed using analysis of variance (ANOVA). The significance level used for both tests was 5%. In the intragroup assessment, the Friedman test showed that only the CPP-ACPF group showed no statistically significant difference (p<0.05) between baseline and first bleaching session. In the intergroup assessment, the Kruskal–Wallis test showed that the CPPG had less postoperative sensitivity after the first session, when compared to the other groups (p<0.05). Color change analysis (ΔE) showed a significant difference between the means obtained in the different bleaching sessions in all groups (p<0.05).Conclusions This study showed that the combination of CPP-ACPF with 35% hydrogen peroxide significantly reduced post-operative sensitivity in the first session, compared with the other evaluated treatments. The association of CPP-ACPF and NovaMin did not affect the color change induced by tooth bleaching.