Women are taking the hit: Examining the unique consequences of cannabis use across the female lifespan.

Cannabis use has risen dramatically in recent years due to global decriminalization and a resurgence in the interest of potential therapeutic benefits. While emerging research is shaping our understanding of the benefits and harms of cannabis, there remains a paucity of data specifically focused on how cannabis affects the female population. The female experience of cannabis use is unique, both in the societal context and because of the biological ramifications. This is increasingly important given the rise in cannabis potency, as well as the implications this has for the prevalence of Cannabis Use Disorder (CUD). Therefore, this scoping review aims to discuss the prevalence of cannabis use and CUD in women throughout their lifespan and provide a balanced prospective on the positive and negative consequences of cannabis use. In doing so, this review will highlight the necessity for continued research that goes beyond sex differences.

SARS-CoV-2 transmission dynamics in the urban-rural interface.

OBJECTIVES: As the world responds to the coronavirus outbreak, the role of public health in ensuring equitable health care that considers the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) dynamics in rural communities is still a challenge. The same suppression and mitigation measures have been implemented homogeneously, ignoring the differences between urban and rural areas. We propose an epidemiological model and simulate the dynamics of SARS-CoV-2 in urban and rural areas considering the interaction between these regions. STUDY DESIGN: This was a population modeling study. METHODS: A compartmental epidemiological model was formulated to simulate the transmission of SARS-CoV-2 in urban and rural areas. We use the model to investigate the impact of control strategies focused on the urban-rural interface to contain the epidemic size of SARS-CoV-2 in rural areas. RESULTS: Considering five different levels for the exposition rate in urban areas and keeping intrarural and urban-rural exposition rates fixed, the preventive measures reduce the size and delay the peak for the urban infectives. The response of infected individuals and cumulative deaths in rural areas upon changes in the urban dynamics was small but not negligible. On the other hand, preventive measures focused on the urban-rural interface impact the number of infected individuals and deaths in rural areas. CONCLUSIONS: The maintenance of SARS-CoV-2 in rural areas depends on the interaction of individuals at the urban-rural interface. Thus, restrictive measures established by the governments would not be required within rural areas. We highlight the importance of focused preventive measures on the urban-rural interface to reduce the exposure and avoid the transmission of SARS-CoV-2 to rural communities.

FluoroType® MTB in pleural fluid for diagnosing tuberculosis. / FluoroType® MTB en líquido pleural para el diagnóstico de tuberculosis.

OBJECTIVES: To assess the cost-effectiveness of a nucleic acid amplification test (FluoroType MTB®) in pleural fluid (PF) and sputum to diagnose tuberculous pleural effusion (TPE). We also analysed the increase in diagnostic yield of a second FluoroType MTB® test, obtained through a new thoracentesis, when the first had resulted negative. METHODS: We conducted a prospective single-centre study that included 207 patients with pleural effusion (31 tuberculous and 176 from other causes). Of the 31 cases of TPE, 21 (68%) were confirmed histologically or microbiologically; the other cases were considered probable. RESULTS: The operational characteristics of FluoroType MTB® in PF for identifying tuberculosis were a sensitivity of 13%, a specificity of 99%, a positive likelihood ratio of 11 and a negative likelihood ratio of 0.9. The diagnostic efficacy data for sputum samples was 21%, 91%, 2.4 and 0.9, respectively. The PF and sputum cultures in solid and liquid media had greater sensitivity (36% and 31%, respectively). A second FluoroType MTB® test in PF was negative for 24 patients with TPE, and a first FluoroType MTB® test also negative. Only 2 (6.5%) patients with TPE had a confirmed diagnosis based exclusively on the positive results of the FluoroType MTB® in PF. CONCLUSION: Due to its low sensitivity, the FluoroType MTB® test in PF has a limited role in diagnosing tuberculous pleurisy.

Quality of Life During and After Completion of Neoadjuvant Chemoradiotherapy for Esophageal and Junctional Cancer.

BACKGROUND: The course of health-related quality of life (HRQOL) during and after completion of neoadjuvant chemoradiotherapy (nCRT) for esophageal or junctional carcinoma is unknown. METHODS: This study was a multicenter prospective cohort investigation. Patients with esophageal or cancer to be treated with nCRT plus esophagectomy were eligible for inclusion in the study. The HRQOL of the patients was measured with European Organization for Research and Treatment of Cancer QLQ-C30, QLQ-OG25, and QLQ-CIPN20 questionnaires before and during nCRT, then 2, 4, 6, 8, 10, 12, 14, and 16 weeks after nCRT and before surgery. Predefined end points were based on the hypothesized impact of nCRT. The primary end points were physical functioning, odynophagia, and sensory symptoms. The secondary end points were global quality of life, fatigue, weight loss, and motor symptoms. Mixed modeling analysis was used to evaluate changes over time. RESULTS: Of 106 eligible patients, 96 (91%) were included in the study. The rate of questionnaires returned ranged from 94% to 99% until week 12, then dropped to 78% in week 16 after nCRT. A negative impact of nCRT on all HRQOL end points was observed during the last cycle of nCRT (all p < 0.001) and 2 weeks after nCRT (all p < 0.001). Physical functioning, odynophagia, and sensory symptoms were restored to pretreatment levels respectively 8, 4, and 6 weeks after nCRT. The secondary end points were restored to baseline levels 4-6 weeks after nCRT. Odynophagia, fatigue, and weight loss improved after nCRT compared with baseline levels at respectively 6 (p < 0.001), 16 (p = 0.001), and 12 weeks (p < 0.001). CONCLUSION: After completion of nCRT for esophageal cancer, HRQOL decreases significantly, but all HRQOL end points are restored to baseline levels within 8 weeks. Odynophagia, fatigue, and weight loss improved 6-16 weeks after nCRT compared with baseline levels.

Migration to the US among rural Puerto Ricans who inject drugs: influential factors, sources of support, and challenges for harm reduction interventions.

BACKGROUND: While PWID of Puerto Rican origin have been migrating to the US for decades, the range of factors influencing their migration to the US and the resources they draw on to do so are not well understood. This is particularly true for rural Puerto Rican PWID, and the present study is the first empirical research to document migration patterns among this population. The specificities of their migration raise important challenges that need to be documented in order to implement more effective harm reduction policies at home (Puerto Rico) and abroad (US). METHODS: This paper draws from data obtained employing a modified NHBS survey which was administered to (N =296) PWID in four rural municipalities of Puerto Rico with participants 18 years or older. The primary dependent variables for this paper are the number of times a person has lived in the continental US, and if they are planning on moving to the continental US in the future. RESULTS: Findings suggest that 65% of the sample reported ever lived in the US and that 49% are planning on moving in the future. The number of times living in the US is associated with higher education and older age, but not with self-reported positive HIV or HCV statuses. Planning to move to the US is associated with knowing PWID who have moved or plan to move, negatively associated with age, and is not associated with HIV or HCV status. Around one third of those that lived in the US reported having some sort of support, with the majority receiving support from family sources. No participant received help to enter HIV/HCV treatment. CONCLUSIONS: A multi-region approach to prevention is required to make a dent in curbing HIV/HCV transmission in this population. Understanding PWID migration patterns, risk behaviors, and health care needs in the US is now more important than ever as natural disasters prompted by human-made climate change will only increase in the future, raising demands not only for service providers but also harm reduction policies to cope with an increasing influx of "climate refugees" as PWID move across national borders.

Insecticide susceptibility status in Mexican populations of Stegomyia aegypti (= Aedes aegypti): a nationwide assessment.

In Mexico, mosquito vector-borne diseases are of public health concern as a result of their impact on human morbidity and mortality. The use of insecticides against adult mosquitoes is one of the most common ways of controlling mosquito population densities. However, the use of these compounds has resulted in the development of insecticide resistance. The aim of this study was to estimate susceptibility to six pyrethroids, two carbamates and two organophosphates in Mexican populations of Stegomyia aegypti (Linnaeus, 1762) (= Aedes aegypti) (Diptera: Culicidae) mosquitoes. Bottle insecticide susceptibility tests, with 1 h exposure, were performed on adult mosquitoes from 75 localities across 28 states. At 30 min of exposure, the proportion of fallen mosquitoes was recorded. After 60 min of exposure, mosquitoes were recovered in non-treated containers and mortality was determined at 24 h after the set-up of the experiment. In general, the carbamate insecticides represented the most effective group in terms of the proportion of mosquitoes fallen at 30 min (72-100%) and 24-h mortality (97-100%). High and widespread resistance to pyrethroids Types I and II and, to a lesser extent, to organophosphates was observed. Insecticide susceptibility among and within states was highly variable.

First report of Stegomyia aegypti (= Aedes aegypti) in Mexico City, Mexico.

Stegomyia aegypti (= Aedes aegypti) (Diptera: Culicidae) is a species of mosquito that is currently widespread in Mexico. Historically, the mosquito has been distributed across most tropical and subtropical areas lower than 1700 m a.s.l. Currently, populations that are found at higher altitudes in regions with cold and dry climates suggest that these conditions do not limit the colonization and population growth of S. aegypti. During a survey of mosquitoes in September 2015, larvae of S. aegypti mosquitoes were found in two different localities in Mexico City, which is located at about 2250 m a.s.l. Mexico City is the most populous city in Mexico and has inefficient drainage and water supply systems. These factors may result in the provision of numerous larval breeding sites. Mosquito monitoring and surveillance are now priorities for the city.

A basic dynamic transmission model of Staphylococcus aureus in the US population--ERRATUM.

doi: http://dx.doi.org/10.1017/S0950268813001106. Published online: 23 May 2013. In the above-mentioned article [1] the y axis in Figure 3a is incorrect. The correct version is given below. US pop. growth (estimated) (×108)

Temporal genetic stability of Stegomyia aegypti (= Aedes aegypti) populations.

The mosquito Stegomyia aegypti (= Aedes aegypti) (Diptera: Culicidae) is the primary vector of viruses that cause yellow fever, dengue and Chikungunya fever. In the absence of effective vaccines, the reduction of these diseases relies on vector control strategies. The success of these strategies is tightly linked to the population dynamics of target populations. In the present study, 14 collections from St. aegypti populations separated by periods of 1-13 years were analysed to determine their temporal genetic stability. Although temporal structure is discernible in most populations, the degree of temporal differentiation is dependent on the population and does not obscure the geographic structure of the various populations. The results suggest that performing detailed studies in the years prior to and after population reduction- or modification-based control interventions at each target field site may be useful in assessing the probability of success.

[Acute pancreatitis in pregnancy]. / Pancreatitis aguda durante el embarazo.

BACKGROUND: Acute pancreatitis is an inflammatory disease that affects the pancreatic tissue, which have been proposed numerous causes, with unpredictable results, it appears as a complication of rare occurrence, so the information on maternal and fetal complications is limited. Objective: Exposing obstetric and perinatal outcomes of patients diagnosed with pancreatitis complicating pregnancy. METHODOLOGY: A retrospective, observational, transverse and descriptive study; data were obtained and analyzed by reviewing medical records of patients diagnosed with pancreatitis and pregnancy. RESULTS: A total of 9 cases were included, corresponding to an incidence of 39/100,000 live births in the time period analyzed. The median age was 22, the mean gestational age at diagnosis was 31 weeks. 4 patients had cesarean delivery and 2 patients natural delivery. 3 patients had Ranson 3, a 2 and other Ranson Ranson 1 the remaining 4 Ranson 0. All products had adequate evolution. A case of maternal death as a complication of the disease was presented, because of metabolic acidosis and ARDS. CONCLUSION: Acute pancreatitis is an entity of variable incidence, which increases their appearance with advancing pregnancy, and can lead to serious complications for pregnant women. It is extremely important to pay attention to early symptoms of the disease, and achieve an accurate diagnosis and provide adequate multidisciplinary management for a better prognosis for maternal-fetal binomial.

Common DNA methylation alterations in multiple brain regions in autism.

Autism spectrum disorders (ASD) are increasingly common neurodevelopmental disorders defined clinically by a triad of features including impairment in social interaction, impairment in communication in social situations and restricted and repetitive patterns of behavior and interests, with considerable phenotypic heterogeneity among individuals. Although heritability estimates for ASD are high, conventional genetic-based efforts to identify genes involved in ASD have yielded only few reproducible candidate genes that account for only a small proportion of ASDs. There is mounting evidence to suggest environmental and epigenetic factors play a stronger role in the etiology of ASD than previously thought. To begin to understand the contribution of epigenetics to ASD, we have examined DNA methylation (DNAm) in a pilot study of postmortem brain tissue from 19 autism cases and 21 unrelated controls, among three brain regions including dorsolateral prefrontal cortex, temporal cortex and cerebellum. We measured over 485,000 CpG loci across a diverse set of functionally relevant genomic regions using the Infinium HumanMethylation450 BeadChip and identified four genome-wide significant differentially methylated regions (DMRs) using a bump hunting approach and a permutation-based multiple testing correction method. We replicated 3/4 DMRs identified in our genome-wide screen in a different set of samples and across different brain regions. The DMRs identified in this study represent suggestive evidence for commonly altered methylation sites in ASD and provide several promising new candidate genes.

Progression from severe sepsis in pregnancy to death: a UK population-based case-control analysis.

OBJECTIVE: To identify factors associated with progression from pregnancy-associated severe sepsis to death in the UK. DESIGN: A population-based case-control analysis using data from the UK Obstetric Surveillance System (UKOSS) and the UK Confidential Enquiry into Maternal Death (CEMD). SETTING: All pregnancy care and death settings in UK hospitals. POPULATION: All non-influenza sepsis-related maternal deaths (January 2009 to December 2012) were included as cases (n = 43), and all women who survived severe non-influenza sepsis in pregnancy (June 2011 to May 2012) were included as controls (n = 358). METHODS: Cases and controls were identified using the CEMD and UKOSS. Multivariable logistic regression was used to estimate adjusted odds ratios (aOR) with 95% confidence intervals. MAIN OUTCOME MEASURES: Odds ratios for socio-demographic, medical, obstetric and management factors in women who died from sepsis, compared with those who survived. RESULTS: Four factors were included in the final regression model. Women who died were more likely to have never received antibiotics [aOR = 22.7, 95% confidence interval (CI) 3.64-141.6], to have medical comorbidities (aOR = 2.53, 95%CI 1.23-5.23) and to be multiparous (aOR = 3.57, 95%CI 1.62-7.89). Anaemia (aOR = 13.5, 95%CI 3.17-57.6) and immunosuppression (aOR = 15.0, 95%CI 1.93-116.9) were the two most important factors driving the association between medical comorbidities and progression to death. CONCLUSIONS: There must be continued vigilance for the risks of infection in pregnant women with medical comorbidities. Improved adherence to national guidelines, alongside prompt recognition and treatment with antibiotics, may reduce the burden from sepsis-related maternal deaths. TWEETABLE ABSTRACT: Medical comorbidities, multiparity and antibiotic delays increase the risk of death from maternal sepsis.

A basic dynamic transmission model of Staphylococcus aureus in the US population.

We present a basic mathematical model of Staphylococcus aureus transmission in the USA based on natural history of infection and nationally representative data. We employed a Susceptible-Colonized-Infected-Recovered-Susceptible compartmental modelling framework with two different phenotypes of S. aureus: methicillin-susceptible (MSSA) and methicillin-resistant (MRSA). The model is dynamic and accounts for the US population growth. For model calibration/validation, we used published 1999-2005 S. aureus infection data in conjunction with the 2001-2004 National Health and Nutrition Examination Survey colonization data. Baseline model projections illustrated how MRSA might continue to expand and gradually replace MSSA over time, in the absence of intervention, if there is strong competition for colonization. The model-based estimate of the basic reproduction number (R0) highlights the need for infection control. We illustrate the potential population-level impact of intervention with a hypothetical S. aureus vaccination component.

Maternal near-miss case reviews: the UK approach.

The UK has a well-established programme of Confidential Enquiries into Maternal Deaths and a national system for research into near-miss maternal morbidities, the UK Obstetric Surveillance System. The addition of a programme of near-miss case reviews, the Confidential Enquiries into Maternal Morbidity, permits a complete examination of the incidence, risk factors, care and outcomes of the severest complications in pregnancy, and enables the lessons learnt to improve future care to be identified more quickly. This in turn allows for more rapid inclusion of recommendations into national guidance and hence the potential of better health for both women and babies.

Doppler images of intrapulmonary arteries within atelectasis and its impact on right ventricular afterload with transesophageal echocardiography.

Video-assisted thoracoscopy (VATS) cardiac surgery requires one-lung ventilation (OLV) and transoesophageal ultrasound (TOE) monitoring. Colour and spectral Doppler make it possible to study the pattern of blood flow in the pulmonary vessels within the atelectatic lung. In this case report we describe how TOE can be used to detect blood flow within the atelectatic lung and to assess pulmonary vascular resistance (PVR) and right ventricular (RV) afterload. FINDINGS: Three anaesthetised, mechanically ventilated adults scheduled for cardiac surgery by VATS were scanned with TOE. After left OLV, the transducer was rotated away from the heart to obtain 2D colour Doppler images of blood flow within the consolidated lung parenchyma. We were able to identify the flow pattern of the intrapulmonary branches of the pulmonary artery. PVR was recorded using pulsed cardiac Doppler at baseline, after induction of general anaesthesia, 20 min after OLV and at the end of OLV, and after performing an alveolar recruitment manoeuvre (ARM) that led to complete resolution of the aforementioned consolidation. CONCLUSIONS: TOE is a semi-invasive imaging tool that can be used to diagnose and study PVR-induced atelectasis and to analyse the resulting pulmonary shunt and its possible effect on PVR.

Developmental ethanol exposure produces deficits in long-term potentiation in vivo that persist following postnatal choline supplementation.

BACKGROUND: Fetal alcohol spectrum disorder (FASD) is one of the leading causes of neurodevelopmental disorder for which there is a pressing need for an effective treatment. Recent studies have investigated the essential nutrient choline as a postnatal treatment option. Supplementation with choline has produced improvements in behavioral tasks related to learning and memory and reverted changes in methylation signature following third-trimester equivalent ethanol exposure. We examined whether there are related improvements in hippocampal synaptic plasticity in vivo. METHODS: Sprague-Dawley offspring were administered binge-levels of ethanol from postnatal day (PND) 4 to 9, then treated with choline chloride (100 mg/kg/day) from PND 10 to 30. In vivo electrophysiology was performed on male and female offspring from PND 55 to 70. Long-term potentiation (LTP) was induced in the medial perforant pathway of the dentate gyrus using a theta-burst stimulation (TBS) protocol, and field-evoked postsynaptic potentials (EPSPs) were evoked for 60 min following the conditioning stimulus. RESULTS: Developmental ethanol exposure caused long-lasting deficits in LTP of the slope of the evoked responses and in the amplitude of the population spike potentiation. Neither deficit was rescued by postnatal choline supplementation. CONCLUSIONS: In contrast to our prior findings that choline can improve hippocampal plasticity (Nutrients, 2022, 14, 2004), here we found that deficits in hippocampal synaptic plasticity due to developmental ethanol exposure persisted into adulthood despite adolescent choline supplementation. Future research should examine more subtle changes in synaptic plasticity to identify synaptic changes that mirror behavioral improvements.

Comparative effectiveness and cost-effectiveness of natalizumab and fingolimod in rapidly evolving severe relapsing-remitting multiple sclerosis in the United Kingdom.

AIM: To evaluate the real-world comparative effectiveness and the cost-effectiveness, from a UK National Health Service perspective, of natalizumab versus fingolimod in patients with rapidly evolving severe relapsing-remitting multiple sclerosis (RES-RRMS). METHODS: Real-world data from the MSBase Registry were obtained for patients with RES-RRMS who were previously either naive to disease-modifying therapies or had been treated with interferon-based therapies, glatiramer acetate, dimethyl fumarate, or teriflunomide (collectively known as BRACETD). Matched cohorts were selected by 3-way multinomial propensity score matching, and the annualized relapse rate (ARR) and 6-month-confirmed disability worsening (CDW6M) and improvement (CDI6M) were compared between treatment groups. Comparative effectiveness results were used in a cost-effectiveness model comparing natalizumab and fingolimod, using an established Markov structure over a lifetime horizon with health states based on the Expanded Disability Status Scale. Additional model data sources included the UK MS Survey 2015, published literature, and publicly available sources. RESULTS: In the comparative effectiveness analysis, we found a significantly lower ARR for patients starting natalizumab compared with fingolimod (rate ratio [RR] = 0.65; 95% confidence interval [CI], 0.57-0.73) or BRACETD (RR = 0.46; 95% CI, 0.42-0.53). Similarly, CDI6M was higher for patients starting natalizumab compared with fingolimod (hazard ratio [HR] = 1.25; 95% CI, 1.01-1.55) and BRACETD (HR = 1.46; 95% CI, 1.16-1.85). In patients starting fingolimod, we found a lower ARR (RR = 0.72; 95% CI, 0.65-0.80) compared with starting BRACETD, but no difference in CDI6M (HR = 1.17; 95% CI, 0.91-1.50). Differences in CDW6M were not found between the treatment groups. In the base-case cost-effectiveness analysis, natalizumab dominated fingolimod (0.302 higher quality-adjusted life-years [QALYs] and £17,141 lower predicted lifetime costs). Similar cost-effectiveness results were observed across sensitivity analyses. CONCLUSIONS: This MSBase Registry analysis suggests that natalizumab improves clinical outcomes when compared with fingolimod, which translates to higher QALYs and lower costs in UK patients with RES-RRMS.

There are several medications used to treat people with relapsing remitting multiple sclerosis, such as interferon-based therapies (Betaferon/Betaseron (US), Rebif, Avonex, Extavia), glatiramer acetate (Copaxone), teriflunomide (Aubagio), and dimethyl fumarate (Tecfidera), collectively named BRACETD. Other treatments for multiple sclerosis (MS) have a narrower use, such as natalizumab (Tysabri) or fingolimod (Gilenya), among others.This study objective was to assess how well natalizumab and fingolimod helped treating MS (clinical effectiveness) and subsequently estimate what the cost of these treatments is in comparison to the benefit they bring to people with rapidly evolving severe MS that use them in the United Kingdom (UK) (cost-effectiveness).We used an international disease registry (MSBase), which collects clinical data from people with MS in various centers around the world to compare the effectiveness of natalizumab, fingolimod and BRACETD treatments. We used a technique called propensity score matching to obtain results from comparable patient groups. People treated with natalizumab had better disease control, namely with fewer relapses and higher improvement on their disability level, than patients on fingolimod or BRACETD. Conversely, there were no differences between each group of people on a measure called disability worsening.Based on these clinical results, we built an economic model that simulates the lifetime costs and consequences of treating people with MS with natalizumab in comparison with fingolimod. We found that using natalizumab was less costly and was more effective compared to using fingolimod in UK patients.

[Imaging findings in neurocysticercosis]. / Neurocisticercosis. Hallazgos radiológicos.

Neurocysticercosis, caused by the larvae of Taenia solium, is the parasitic infection that most commonly involves the central nervous system in humans. Neurocysticercosis is endemic in practically all developing countries, and owing to globalization and immigration it is becoming more common in developed countries like those in western Europe. The most common clinical manifestations are epilepsy, focal neurologic signs, and intracranial hypertension. The imaging findings depend on the larval stage of Taenia solium, on the number and location of the parasites (parenchymal, subarachnoid, or intraventricular), as well as on the host's immune response (edema, gliosis, arachnoiditis) and on the development of secondary lesions (arteritis, infarcts, or hydrocephalus). The diagnosis of this parasitosis must be established on the basis of the clinical and radiological findings, especially in the appropriate epidemiological context, with the help of serological tests.

Photoplethysmography waveform analysis for classification of vascular tone and arterial blood pressure: Study based on neural networks.

BACKGROUND: To test whether a Shallow Neural Network (S-NN) can detect and classify vascular tone dependent changes in arterial blood pressure (ABP) by advanced photopletysmographic (PPG) waveform analysis. METHODS: PPG and invasive ABP signals were recorded in 26 patients undergoing scheduled general surgery. We studied the occurrence of episodes of hypertension (systolic arterial pressure (SAP) >140 mmHg), normotension and hypotension (SAP < 90 mmHg). Vascular tone according to PPG was classified in two ways: 1) By visual inspection of changes in PPG waveform amplitude and dichrotic notch position; where Classes I-II represent vasoconstriction (notch placed >50% of PPG amplitude in small amplitude waves), Class III normal vascular tone (notch placed between 20-50% of PPG amplitude in normal waves) and Classes IV-V-VI vasodilation (notch <20% of PPG amplitude in large waves). 2) By an automated analysis, using S-NN trained and validated system that combines seven PPG derived parameters. RESULTS: The visual assessment was precise in detecting hypotension (sensitivity 91%, specificity 86% and accuracy 88%) and hypertension (sensitivity 93%, specificity 88% and accuracy 90%). Normotension presented as a visual Class III (III-III) (median and 1st-3rd quartiles), hypotension as a Class V (IV-VI) and hypertension as a Class II (I-III); all p < .0001. The automated S-NN performed well in classifying ABP conditions. The percentage of data with correct classification by S-ANN was 83% for normotension, 94% for hypotension, and 90% for hypertension. CONCLUSIONS: Changes in ABP were correctly classified automatically by S-NN analysis of the PPG waveform contour.

Expression and properties of hyperpolarization-activated current in rat dorsal root ganglion neurons with known sensory function.

The hyperpolarization-activated current (I(h)) has been implicated in nociception/pain, but its expression levels in nociceptors remained unknown. We recorded I(h) magnitude and properties by voltage clamp from dorsal root ganglion (DRG) neurons in vivo, after classifying them as nociceptive or low-threshold-mechanoreceptors (LTMs) and as having C-, Aδ- or Aα/ß-conduction velocities (CVs). For both nociceptors andLTMs, I(h) amplitude and I(h) density (at -100 mV) were significantly positively correlated with CV.Median I(h) magnitudes and I(h) density in neuronal subgroupswere respectively:muscle spindle afferents(MSAs):-4.6 nA,-33 pA pF(-1); cutaneous Aα/ß LTMs: -2.2 nA, -20 pA pF(-1); Aß-nociceptors: -2.6 nA, -21 pA pF(-1); both Aδ-LTMs and nociceptors: -1.3 nA, ∼-14 pA pF(-1); C-LTMs: -0.4 nA, -7.6 pA pF(-1); and C-nociceptors: -0.26 nA, -5 pApF(-1). I(h) activation slow time constants (slow τ values) were strongly correlated with fast τ values; both were shortest in MSAs. Most neurons had τ values consistent with HCN1-related I(h); others had τ values closer to HCN1+HCN2 channels, or HCN2 in the presence of cAMP. In contrast, median half-activation voltages (V(0.5)) of -80 to -86 mV for neuronal subgroups suggest contributions of HCN2 to I(h). τ values were unrelated to CV but were inversely correlated with I(h) and I(h) density for all non-MSA LTMs, and for Aδ-nociceptors. From activation curves ∼2-7% of I(h)would be activated at normal membrane potentials. The high I(h) may be important for excitability of A-nociceptors (responsible for sharp/pricking-type pain) and Aα/ß-LTMs (tactile sensations and proprioception). Underlying HCN expression in these subgroups therefore needs to be determined. Altered high I(h) may be important for excitability of A-nociceptors (responsible for sharp/pricking-type pain) and Aα/ß-LTMs (tactile sensations and proprioception). Underlying HCN expression in these subgroups therefore needs to be determined. Altered Ih expression and/or properties (e.g. in chronic/pathological pain states) may influence both nociceptor and LTM excitability.expression and/or properties (e.g. in chronic/pathological pain states) may influence both nociceptor and LTM excitability.