PainVision-based evaluation of brain potentials: a novel approach for quantitative pain assessment.

Introduction: The complex and multidimensional nature of pain poses a major challenge in clinical pain assessments. In this study, we aimed to evaluate a novel approach combining quantitative sensory testing (QST) with event-related potential measurements for assessment of experimental pain in healthy individuals. Methods: QST was performed with a commercial device (PainVision, PS-2100), and numeric rating scale (NRS) scores after exposure to different sensory stimuli were reported by the participants. Resting-state electroencephalography (EEG) was simultaneously performed to capture the cortical responses to peripheral stimulation. Results: Pain scores increased with the intensity of stimuli, with mean NRS scores of 2.7 ± 1.0 after mild stimuli and 5.6 ± 1.0 after moderate stimuli. A reproducible, significant P2-N2 complex was evoked by both mild and moderately painful stimuli, but not by non-painful stimuli. The latency of pain-related potentials was not significantly different between stimuli. The amplitudes of both P2 and N2 components significantly increased when intense nociception was applied, and the increments mainly originated from theta oscillations. Conclusion: The combination of QST with EEG was feasible for subjective and objective pain assessment. Distinct patterns of brain potentials were associated with the phenotype of the peripheral stimuli (e.g., noxious versus. innoxious, high versus. low pain intensity).

A novel implantable device for sensory and affective assessment of orofacial pain in rats.

Background and objective: Orofacial pain, in particular, chronic orofacial pain remains a great challenge in clinical practice. To better understand the underlying mechanism of disease, it is essential to apply a feasible and stable preclinical measurement of facial pain. Here, we introduced a novel electrical noxious stimulator in freely behavioral rodents and examined its validation in both naïve and chronic orofacial pain animals. Methods: One subcutaneous device of electrical stimulator was implanted in the facial region for delivery of the nociceptive input. The sensory component of orofacial pain was assessed by response scoring tool, and conditioned place aversion (CPA) paradigm for pain affect respectively. To confirm its usage in chronic pain state, the chronic constriction injury of the infraorbital nerve (ION-CCI) model was then applied. Results: We found that responsive scores increased with stimulation intensity, and acted in a dosage-dependent manner, which can be attenuated by the administration of morphine intraperitoneally. Naïve rats displayed significant aversive reaction to the noxious electrical stimulation (25V) in the CPA testing. In addition, an obvious sensory hypersensitivity to electrical stimulation was confirmed by the increased response scores in ION-CCI rats. Furthermore, ION-CCI animal showed significant avoidance to electrical stimulation at relatively low intensity (10V), which was innoxious to naïve rats. Conclusion: Our findings may provide an alternative pre-clinical measurement of orofacial pain, to quantitively assess both sensory and affective component of orofacial pain.

A Low-Cost Flexible Perforated Respiratory Sensor Based on Platinum for Continuous Respiratory Monitoring.

Monitoring sleep conditions is of importance for sleep quality evaluation and sleep disease diagnosis. Accurate respiration detection provides key information about sleep conditions. Here, we propose a perforated temperature sensor that can be worn below the nasal cavity to monitor breath. The sensing system consists of two perforated temperature sensors, signal conditioning circuits, a transmission module, and a supporting analysis algorithm. The perforated structure effectively enhances the sensitivity of the system and shortens the response time. The sensor's response time is 0.07 s in air and sensitivity is 1.4‱°C-1. The device can achieve a monitoring respiratory temperature range between normal room temperature and 40 °C. The simple and standard micromachining process ensures low cost and high reproducibility. We achieved the monitoring of different breathing patterns, such as normal breathing, panting, and apnea, which can be applied to sleep breath monitoring and exercise information recording.

Spatiotemporal, kinematic and kinetic assessment of the effects of a foot drop stimulator for home-based rehabilitation of patients with chronic stroke: a randomized clinical trial.

BACKGROUND: Gait disability affects the daily lives of patients with stroke in both home and community settings. An abnormal foot-ankle position can cause instability on the supporting surface and negatively affect gait. Our research team explored the ability of a portable peroneal nerve-targeting electrical stimulator to improve gait ability by adjusting the foot-ankle position during walking in patients with chronic stroke undergoing home-based rehabilitation. METHODS: This was a double-blinded, parallel-group randomized controlled trial. Thirty-one patients with chronic stroke and ankle-foot motor impairment were randomized to receive 3 weeks of gait training, which involved using the transcutaneous peroneal nerve stimulator while walking (tPNS group; n = 16, mean age: 52.25 years), or conventional home and/or community gait training therapy (CT group; n = 15, mean age: 54.8 years). Functional assessments were performed before and after the 3-week intervention. The outcome measures included spatiotemporal gait parameters, three-dimensional kinematic and kinetic data on the ankle-foot joint, and a clinical motor and balance function assessment based on the Fugl-Meyer Assessment of Lower Extremity (FMA-LE) and Berg Balance scales (BBS). Additionally, 16 age-matched healthy adults served as a baseline control of three-dimensional gait data for both trial groups. RESULTS: The FMA-LE and BBS scores improved in both the tPNS groups (p = 0.004 and 0.001, respectively) and CT groups (p = 0.034 and 0.028, respectively) from before to after training. Participants in the tPNS group exhibited significant differences in spatiotemporal gait parameters, including double feet support, stride length, and walking speed of affected side, and the unaffected foot off within a gait cycle after training (p = 0.043, 0.017, 0.001 and 0.010, respectively). Additionally, the tPNS group exhibited significant differences in kinematic parameters, such as the ankle angle at the transverse plane (p = 0.021) and foot progression angle at the frontal plane (p = 0.009) upon initial contact, and the peak ankle joint angle at the transverse plane (p = 0.023) and foot progression angle (FPA) at the frontal and transverse planes (p = 0.032 and 0.046, respectively) during gait cycles after 3 weeks of training. CONCLUSIONS: Use of a portable tPNS device during walking tasks appeared to improve spatiotemporal gait parameters and ankle and foot angles more effectively than conventional home rehabilitation in patients with chronic stroke. Although guidelines for home-based rehabilitation training services and an increasing variety of market devices are available, no evidence for improvement of motor function and balance was superior to conventional rehabilitation. Trial registration Chictr, ChiCTR2000040137. Registered 22 November 2020, https://www.chictr.org.cn/showproj.aspx?proj=64424.

Correlations between leaf economics, mechanical resistance and drought tolerance across 41 cycad species.

BACKGROUND AND AIMS: We conducted a comprehensive analysis of the functional traits of leaves (leaflets) of cycads. The aim of this study was to clarify the functional divergence between the earlier origin Cycadaceae and the later differentiated Zamiaceae, and the differences in trait associations between cycads and angiosperms. METHODS: We selected 20 Cycadaceae species and 21 Zamiaceae species from the same cycad garden in South China, and measured their leaf structure, economic traits, mechanical resistance (Fp) and leaf water potential at the turgor loss point (πtlp). In addition, we compiled a dataset of geographical distribution along with climatic variables for these cycad species, and some leaf traits of tropical-sub-tropical angiosperm woody species from the literature for comparison. KEY RESULTS: The results showed significantly contrasting leaf trait syndromes between the two families, with Zamiaceae species exhibiting thicker leaves, higher carbon investments and greater Fp than Cycadaceae species. Leaf thickness (LT) and πtlp were correlated with mean climatic variables in their native distribution ranges, indicating their evolutionary adaptation to environmental conditions. Compared with the leaves of angiosperms, the cycad leaves were thicker and tougher, and more tolerant to desiccation. Greater Fp was associated with a higher structural investment in both angiosperms and cycads; however, cycads showed lower Fp at a given leaf mass per area or LT than angiosperms. Enhancement of Fp led to more negative πtlp in angiosperms, but the opposite trend was observed in cycads. CONCLUSIONS: Our results reveal that variations in leaf traits of cycads are mainly influenced by taxonomy and the environment of their native range. We also demonstrate similar leaf functional associations in terms of economics, but different relationships with regard to mechanics and drought tolerance between cycads and angiosperms. This study expands our understanding of the ecological strategies and likely responses of cycads to future climate change.

Computational Assessment of the Expression-modulating Potential for Noncoding Variants.

Large-scale genome-wide association studies (GWAS) and expression quantitative trait loci (eQTLs) studies have identified multiple noncoding variants associated with genetic diseases by affecting gene expression. However, pinpointing causal variants effectively and efficiently remains a serious challenge. Here, we developed CARMEN, a novel algorithm to identify functional noncoding expression-modulating variants. Multiple evaluations demonstrated CARMEN's superior performance over state-of-the-art tools. Applying CARMEN to GWAS and eQTLs datasets further pinpoints several causal variants other than reported lead single-nucleotide polymorphisms (SNPs). CARMEN scales well with the massive datasets and is available online as a web server at http://carmen.gao-lab.org.

Household food waste in rural China: A noteworthy reality and a systematic analysis.

Economic development has improved people's daily diets in China, but food waste has increased significantly. China faces severe natural resource constraints, and reducing food waste is important for ensuring national food security. Based on 1634 survey samples from 28 provinces in China, this study assessed food waste in rural China and empirically analyzed the main factors affecting rural household food waste. The results showed that, on average, 1.67% of food is wasted per household each day in rural China. Food waste is greater in economically developed areas, such as East China. Empirical analysis showed that cooking utensils, preparing the right amount of food, religious beliefs, number of family members, average weight of family members, percentage of purchased grain in the total food consumption in 1 year, and total grain output are significantly related to rural household food waste.

Comparison between the Khorana prediction score and Caprini risk assessment models for assessing the risk of venous thromboembolism in hospitalized patients with cancer: a retrospective case control study.

OBJECTIVES: This study aimed to evaluate the optimal risk assessment model (RAM) to stratify the risk of venous thromboembolism (VTE) in hospitalized patients with cancer. We examined and compared the VTE predictive ability of the Khorana score (KS) and the Caprini RAM in hospitalized cancer patients. METHODS: We performed a retrospective case-control study among hospitalized cancer patients admitted to a comprehensive hospital in China from January 2015 to December 2016. A total of 221 cases were confirmed to have VTE during hospitalization and 221 controls were selected randomly. The Caprini RAM and KS were implemented and the individual scores of each risk factor were summed to generate a cumulative risk score. Meanwhile, the sensitivity, specificity, areas under curve of the receiver operating characteristic curve and calibration of these 2 models were analysed. RESULTS: Significant differences were observed in risk factors between VTE and non-VTE hospitalized cancer patients and the VTE risk increased significantly with an increase in the cumulative KS or Caprini RAM score. A classification of 'high risk' according to KS and Caprini RAM was associated with 2.272-fold and 3.825-fold increases in VTE risk, respectively. However, the Caprini RAM could identify 82.4% of the VTE cases that required preventive anticoagulant therapy according to American College of Chest Physicians guidelines, whereas the KS could only identify 35.3% of the VTE cases. In addition, the areas under curve of Caprini RAM were significantly higher than those of the KS (0.705 ± 0.024 vs 0.581 ± 0.025, P < 0.001), with a best cut-off value of 5 score, which happened to be the cut-off value for high risk of VTE in Caprini RAM. Both Caprini RAM and KS showed an excellent calibration curve (0.612 vs 0.141, P > 0.05), but the risk of VTE events predicted by Caprini seemed closer to the observed risk of VTE events. CONCLUSIONS: The Caprini RAM was found to be more effective than the KS in identifying hospitalized patients with cancer at risk of VTE.

The Chinese Association for the Study of Pain (CASP): Consensus on the Assessment and Management of Chronic Nonspecific Low Back Pain.

Chronic nonspecific low back pain (CNLBP) is defined as pain or discomfort originating from the waist, which lasts for at least 12 weeks, but no radiculopathy or specific spinal diseases. CNLBP is a complicated medical problem and places a huge burden on healthcare systems. Clinical manifestation of CNLBP includes discogenic LBP, zygapophyseal joint pain, sacroiliac joint pain, and lumbar muscle strain. Further evaluation should be completed to confirm the diagnosis including auxiliary examination, functional assessment, and clinical assessment. The principle of the management is to relieve pain, restore function, and avoid recurrence. Treatment includes conservative treatment, minimally invasive treatment, and rehabilitation. Pharmacologic therapy is the first-line treatment of nonspecific LBP, and it is most widely used in clinical practice. Interventional therapy should be considered only after failure of medication and physical therapy. Multidisciplinary rehabilitation can improve physical function and alleviate short-term and long-term pain. The emphasis should be put on the prevention of NLBP and reducing relevant risk factors.

Microcatheter collateral channel tracking failure in retrograde percutaneous coronary intervention for chronic total occlusion: incidence, predictors, and management.

AIMS: This study sought to demonstrate the incidence, predictors, and management of microcatheter collateral channel (CC) tracking failure in retrograde percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions. METHODS AND RESULTS: Prospectively collected data from 371 consecutive retrograde CTO-PCI procedures between March 2015 and January 2018 were retrospectively analysed. The incidence of initial microcatheter CC tracking failure was 22.5% in 280 procedures with wire CC tracking success. For septal collaterals, CC grade 0-1 collaterals (odds ratio [OR]: 8.3; p<0.001), channel entry angle <90° (OR: 13.0; p=0.001), channel exit angle <90° (OR: 44.3; p=0.004), and Finecross MG as initial microcatheter (OR: 2.7; p=0.032) were independently related to initial microcatheter CC tracking failure. Meanwhile, the only predictor for epicardial collaterals was CC 1 collaterals (OR: 26.9; p<0.001). Frequently applied solutions included microcatheter switching (61.9%), and microcatheter switching combined with GUIDEZILLA (14.3%) or anchoring balloon technique (6.3%). CONCLUSIONS: Initial microcatheter CC tracking failure was found in nearly one quarter of procedures after wire CC tracking success. Independent angiographic predictors of initial microcatheter CC tracking failure included CC 0-1 collaterals, channel entry angle <90°, and channel exit angle <90° for septal collaterals, and CC 1 collaterals for epicardial collaterals.

Assessment of an alternative calibration technique to record breathing pattern and its variability with respiratory inductive plethysmography.

Recent literature has raised doubts on the existing calibration methods for respiratory inductive plethysmography (RIP) which can lead to erroneous estimation of tidal volume. This study sought to validate an alternative calibration method to record tidal volume and tidal volume variability during rest and exercise by comparing the measurements obtained from a RIP device against a pneumotachograph (PT) for breath-by-breath analysis. 11 healthy individuals were recruited. Tidal volume and variability were simultaneously recorded during 30 min of rest and 20 min of exercises. Pearson correlation coefficients for group mean tidal volume between PT and RIP were 0.8 during rest and exercises. No statistical significant difference was observed in tidal volume variability between devices during rest and exercises. This study provides support for an alternative calibration method, which addresses existing limitations. The simplicity of equipment set up process and no need to perform subject cooperated calibration procedure will improve the respiratory monitoring process.

[Intravascular ultrasound assessment of sirolimus-eluting stent restenosis or thrombosis after stent implantation].

OBJECTIVE: To identify underlying mechanical risk factors of that developed in-stent restenosis (ISR) or early stent thrombosis in sirolimus-eluting stent (SES)-treated lesions using intravascular ultrasound (IVUS). METHODS: IVUS were performed in 60 (ISR, n = 43; early stent thrombosis, n = 17) patients (event group) and in 34 patients without ISR and early stent thrombosis (no-event group) underwent SES implantations. RESULTS: Compared with the no-event group, minimum stent area [MSA, (4.6 +/- 1.6) mm(2) vs. (5.8 +/- 1.6) mm(2), P < 0.01], minimum stent diameter [(2.2 +/- 0.5) mm vs. (2.5 +/- 0.4) mm, P < 0.01], and stent expansion [(69.2 +/- 20.7)% vs. (80.6 +/- 17.2)%, P < 0.01] were significantly smaller, and longitudinal stent symmetry index (MSA/maximum stent area, 2.0 +/- 0.6 vs. 1.7 +/- 0.6, P < 0.05) was significantly larger in the event group. Incidence of MSA < 4.0 mm(2) (43.3% vs. 14.7%, P < 0.01) and stent expansion < 60% (40.7% vs. 11.8%, P < 0.01) were more frequent in the event group than that in no-event group. Furthermore, proximal residual plaque burden was significantly higher compared to the no-event group [(49.0 +/- 15.5)% vs. (38.4 +/- 17.6)%, P < 0.01]. Independent predictors of post SES ISR or early thrombosis were MSA (OR:0.7, 95%CI:0.5 - 0.8, P < 0.01) and proximal residual plaque burden (OR: 280.7, 95%CI: 17.2 - 40 583.6, P < 0.01). CONCLUSION: Smaller MSA and higher proximal residual plaque burden are independent predictors of ISR or early thrombosis post SES implantations.