ABSTRACT
Introduction: Neurotrophic Keratopathy (NK) is a neurodegenerative corneal disease that results in diminished corneal sensation. Previous studies have found that Cenegermin 0.002%, a recombinant human nerve growth factor (rhNGF), improves corneal epithelial healing in stage 2 and 3 NK patients. However, rhNGF effect on corneal sensation and nerve regeneration has not been well established. Thus, this study aims to analyze the effect of rhNGF on corneal nerve regeneration using in vivo confocal microscopy (IVCM) and on corneal sensitivity in NK patients. Methods: This is a retrospective, longitudinal, case-control study that included patients with NK, treated with rhNGF for at least 4 weeks, with pre- and post-treatment IVCM images available for analysis. Chart reviews were conducted documenting prior medical and surgical history, clinical signs and symptoms, and corneal sensation using Cochet-Bonnet esthesiometry. Corneal nerve parameters were assessed by IVCM. Sex- and age-matched reference controls were selected from a database of healthy subjects for comparison. Results: The study included 25 patients, with 22 (88%) stage 1, two (8%) stage 2, and 1 (4%) stage 3 NK patients, with a median age of 64 years (range: 30-93 years). Total, main, and branch nerve densities [median (range) in mm/mm2] were lower in the NK group pre-treatment [2.3 (0.0-21.1); 1.7 (0.0-13.0); 0.5 (0.0-10.2); respectively] vs. controls [22.3 (14.9-29.0); 10.1 (3.2-15.4); and 12.1 (6.2-18.4), (p < 0.0001 for all), respectively]. Post-treatment nerve densities increased compared to pre-treatment to 5.3 (0.0-19.4, p = 0.0083) for total, 3.5 (0.0-13.2, p = 0.0059) for main, and 2.0 (0.0-10.4, p = 0.0251) for branch nerves, but remained lower than controls (p < 0.0001 for all). Corneal sensation increased from 2.3 ± 1.1 cm pre-treatment to 4.1 ± 1.4 cm post-treatment (p = 0.001). Median best corrected visual acuity significantly increased following rhNGF treatment from 0.4 (0.0-1.6) to 0.12 (-0.1 to 1.6) (p = 0.007). Conclusion: Patients with NK treated with at least 4 weeks of rhNGF, showed a significant increase in corneal nerve densities after treatment. A significant increase in corneal sensation, as well as best corrected visual acuity, was observed following treatment.
ABSTRACT
Conditioned pain modulation (CPM) can discriminate between healthy and chronic pain patients. However, its relationship with neurophysiological pain mechanisms is poorly understood. Brain oscillations measured by electroencephalography (EEG) might help gain insight into this complex relationship. OBJECTIVE: To investigate the relationship between CPM response and self-reported pain intensity in non-specific chronic low back pain (NSCLBP) and explore respective EEG signatures associated to these mechanisms. DESIGN: Cross-sectional analysis. PARTICIPANTS: Thirty NSCLBP patients participated. METHODS: Self-reported low back pain, questionnaires, mood scales, CPM (static and dynamic quantitative sensory tests), and resting surface EEG data were collected and analyzed. Linear regression models were used for statistical analysis. RESULTS: CPM was not significantly correlated with self-reported pain intensity scores. Relative power of EEG in the beta and high beta bands as recorded from the frontal, central, and parietal cortical areas were significantly associated with CPM. EEG relative power at delta and theta bands as recorded from the central area were significantly correlated with self-reported pain intensity scores while controlling for self-reported depression. CONCLUSIONS: Faster EEG frequencies recorded from pain perception areas may provide a signature of a potential cortical compensation caused by chronic pain states. Slower EEG frequencies may have a critical role in abnormal pain processing.
Subject(s)
Chronic Pain , Low Back Pain , Cross-Sectional Studies , Electroencephalography , Humans , Low Back Pain/diagnosis , Pain Perception/physiology , Pain Threshold/physiologyABSTRACT
BACKGROUND: There is a need of well-powered randomized clinical trials in fibromyalgia. However, challenges for recruitment are presented. This study aims to describe and assess the perception of barriers and facilitators and the associated factors for the participation of underrepresented and non-underrepresented fibromyalgia patients. METHODS: We performed an online survey through REDCap (Research Electronic Data Capture) targeting fibromyalgia patients from April 7 to July 3, 2020 during the COVID-19 stay home mandate and it was restricted to the United States of America. We described and compared the survey characteristics between underrepresented and non-underrepresented participants, and we performed logistic regression models to assess the associated factors with clinical trial participation. RESULTS: In total, 481 completed the survey including 168 underrepresented fibromyalgia patients. Only (1) 11.09 % reported previous participation in clinical trials and the significant perceived barriers were investigator-related (lack of friendliness of research staff and the opportunity to receive the results) and center-related (privacy and confidentiality policies, and the institution's reputation); (2) the participation rate and perceived barriers and facilitators were similar between underrepresented and non-underrepresented patients; and was positively associated with low income, higher age, and clinical trial awareness from their physician; and negatively associated with the perception of investigator-related barriers; and (4) for the underrepresented population, the presence of emotional support. CONCLUSION: Our findings suggest low rates of participation, regardless of underrepresented population status. Strategies as involving their physician as liaison to increase the awareness of clinical trials, as well as improving patient-researcher communication should be considered in this population.
ABSTRACT
OBJETIVO: Conocer la prevalencia, incidencia hospitalaria y epidemiologia del cáncer de ovario en el HNGAI entre enero 2007 y diciembre 2011. PACIENTES Y MÉTODO: Estudio retrospectivo, descriptivo, transversal, epidemiológico de 46 pacientes con tumoraciones malignas de ovario atendidas entre 2007 y 2011 con expedientes completos. RESULTADOS: Los resultados mostraron que la mayor incidencia de Cáncer de Ovario fue entre las edades de 51 y 60 años, asimismo el Adenocarcinoma fue el tipo de neoplasia que se encontró con mayor frecuencia, siendo el subtipo cistoadenocarcinoma mucinoso el más común. En cuanto a los exámenes auxiliares para la ayuda diagnóstica, la ecografía y tomografía pudieron discernir entre maligno y benigno en la mayoría de los casos. (Figura 10 y 11) La mayoría de las pacientes permanecieron entre 6-10 días hospitalizadas luego de la cirugía. El promedio de tiempo operatorio fue entre 2 a 3 horas. En la mayoría de los casos, el resultado anatomopatologico del tumor extraído durante la cirugía estuvo disponible dentro del día de la operación.CONCLUSIONES: Se observó dos picos de edades más frecuentes relacionadas al cáncer de ovario, entre: 10-20 años y 51-60 años. La menarquía temprana no constituyo un factor de riesgo para cáncer de ovario. De todos los casos revisados, no se encontró antecedentes personales ni familiares de cáncer de ovario. Se observó que las complicaciones intraoperatorias y post operatorias fueron muy escasas. El tiempo de hospitalización fue en promedio entre 6-10 días. El tiempo operatorio promedio fue entre 2-3 horas. El resultado anatomopatologico del tumor de ovario fue determinado con mayor frecuencia dentro del día de la cirugía.
OBJETIVE: Determine the prevalence, incidence and epidemiology of ovarian cancer in HNGAI between January 2007 and December 2011. PATIENTS AND METHODS: Retrospective, descriptive, transversal, epidemiological study of 46 patients with ovarian malignancies treated between 2007 and 2011 with complete records. RESULTS: Results showed that the highest incidence of ovarian cancer is between ages 51-60, and adenocarcinoma was the most frequent histological type, subtype mucinous cystadenocarcinoma being the most common. Respecting auxiliary exams for diagnostic help, ultrasound and CT scan could differentiate between malignity and benignity in most cases. (Figures 10 and 11). Most patients were hospitalized between 6-10 days after surgery. The average operating time was between 2 to 3 hours. In most cases, the histopathology of the tumor removed during surgery was available in a day or less of the operation date. CONCLUSIONS: Two peaks were observed for relationship between age and ovarian cancer: 10-20 years old and 51-60 years old. Early menarche did not constitute a risk factor for ovarian cancer. From all reviewed cases, we didnÆt find personal or family history related to ovarian cancer. Intraoperative and postoperative complications were rare. The length of hospital stay was on average between 6-10 days. Mean operative time was between 2-3 hours. The pathology of the ovarian tumor was identified most frequently in the day of surgery.
