Biopsychosocial sequelae and recovery trajectories from whiplash injury following a motor vehicle collision.

BACKGROUND CONTEXT: Five out of 10 injured in a motor vehicle collision (MVC) will develop persistent pain and disability. It is unclear if prolonged symptoms are related to peritraumatic pain/disability, psychological distress, muscle fat, lower extremity weakness. PURPOSE: To test if widespread muscle fat infiltration (MFI) was (1) unique to those with poor recovery, (2) present in the peritraumatic stage, (3) related to known risk factors. STUDY DESIGN/SETTING: A cohort study, single-center academic hospital. PATIENT SAMPLES: A total of 97 men and women (age 18-65) presenting to an urban academic emergency medicine department following MVC, but not requiring inpatient hospitalization. PRIMARY OUTCOME MEASURE: Neck disability at 12-months. METHODS: Participants underwent magnetic resonance imaging (MRI) to quantify neck and lower extremity MFI, completed questionnaires on pain/disability and psychological distress (< 1-week, 2-weeks, 3-, and 12-months) and underwent maximum volitional torque testing of their lower extremities (2-weeks, 3-, and 12-months). Percentage score on the Neck Disability Index at 12-months was used for a model of (1) Recovered (0%-8%), (2) Mild (10%-28%), and (3) Moderate/Severe (≥ 30%). This model was adjusted for BMI and age. RESULTS: Significant differences for neck MFI were revealed, with the Recovered group having significantly lower neck MFI than the Mild and Moderate/Severe groups at all time points. The Mild group had significantly more leg MFI at 12-months (p=.02) than the Recovered group. There were no other significant differences at any other time point. Lower extremity torques revealed no group differences. The Traumatic Injury Distress Scale (TIDS) and MFI of the neck at 1-week postinjury significantly predicted NDI score at 12-months. CONCLUSIONS: Higher neck MFI and distress may represent a risk factor though it is unclear whether this is a pre-existing phenotype or result of the trauma. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02157038.

Whiplash-Associated Dysphagia: Considerations of Potential Incidence and Mechanisms.

Non-specific self-reports of dysphagia have been described in people with whiplash-associated disorders (WAD) following motor vehicle collision (MVC); however, incidence and mechanistic drivers remain poorly understood. Alterations in oropharyngeal dimensions on magnetic resonance imaging (MRI), along with heightened levels of stress, pain, and changes in stress-dependent microRNA expression (e.g., miR-320a) have been also associated with WAD, suggesting multi-factorial issues may underpin any potential swallowing changes. In this exploratory paper, we examine key biopsychosocial parameters in three patients with persistent WAD reporting swallowing change and three nominating full recovery after whiplash with no reported swallowing change. Parameters included (1) oropharyngeal volume with 3D MRI, (2) peritraumatic miR-320a expression, and (3) psychological distress. These factors were explored to highlight the complexity of patient presentation and propose future considerations in relation to a potential deglutition disorder following WAD. The three participants reporting changes in swallowing all had smaller oropharyngeal volumes at < 1 week and at 3 months post injury and lower levels of peritraumatic miR-320a. At 3 months post MVC, oropharyngeal volumes between groups indicated a large effect size (Hedge's g = 0.96). Higher levels of distress were reported at both time points for those with persistent symptomatology, including self-reported dysphagia, however, this was not featured in those nominating recovery. This paper considers current evidence for dysphagia as a potentially under-recognized feature of WAD and highlights the need for future, larger-scaled, multidimensional investigation into the incidence and mechanisms of whiplash-associated dysphagia.

A Commercially Available Capacitive Stretch-Sensitive Sensor for Measurement of Rotational Neck Movement in Healthy People: Proof of Concept.

Freedom of neck range of motion has been identified for decades as an important indicator of neck health. In the past, neck motion has been measured in clinical settings using straight-plane movements that do not represent real-world 'ecological' performance. The tools currently used are low-fidelity analog or digital tools that rely greatly on the orientation of the person with respect to gravity, or the evaluator's ability to accurately align protractor arms with key surface markers for angle measurement. A possible solution lies in the use of wearable sensors for tracking the motion of the neck without clinical instruction. For this purpose, the focus of this paper is on the assessment of a commercially available stretch sensitive sensor, C-Stretch® against a gold standard for motion tracking. The sensor's accuracy and agreement for measuring neck rotations were evaluated. The results show that the stretch sensitive sensor was accurate with an average RMSE of 5.86° (SD=$4.38^{\circ}, \mathrm{n}=2$) and highly correlated $r=0.88-0.99,(p\lt0.01)$ with Aurora, an electromagnetic tracking system. This work may lead to using wearable sensors as a cost-effective, lightweight, and safe alternative to assess real-world neck range of motion for clinical application.

Does a familial subtype of complex regional pain syndrome exist? Results of a systematic review.

Background and Objective: Complex regional pain syndrome (CRPS) is a chronic condition characterized by severe regional pain, allodynia, hyperalgesia, and functional impairment. The aim of this systematic review is to investigate whether a familial subtype of CRPS (fCRPS) exists and to determine whether people with fCRPS have specific characteristics. Methods: Databases CINAHL, Medline, PsycINFO, and PubMed were searched with no date limitation. Quality of reporting was assessed using the Scottish Intercollegiate Guidelines Network scale and the Joanna Briggs Institute's checklists. Results: Eight studies were included. Family relationships were defined as any immediate (i.e., parents or siblings) or blood relatives. A combination of participants with known or unknown causes for CRPS was recruited. The studies in this review support the potential for the existence of fCRPS, although this included less than 25% of those affected. People with potential fCRPS showed more severe symptoms, more sites involved, a higher percentage of spontaneous onset, and earlier age at onset. An elevated sibling recurrence risk ratio of 5.6 (95% confidence interval [CI], 3.0 to 9.8) was reported for people under 50. None of the studies established a pattern of heritability. Therefore, the most likely explanation for heritability would be a multifactorial model in which cumulative and interactive Gene × Environment effects may be involved. Conclusions: This systematic review supports the potential for the existence of fCRPS; however, all identified studies used uncontrolled case reports, case series, and case-control designs that cannot provide evidence of causation. Further studies are required to reveal the heritability and genetic structure of fCRPS.

Contexte et objectifs: Le syndrome de douleur régionale complexe (SDRC) est une maladie chronique qui se caractérise par de fortes douleurs régionales, une allodynie, une hyperalgésie et une déficience fonctionnelle. Le but de cette revue systématique était de vérifier s'il existe un sous-type familial de SDRC (SDRCf) et de déterminer si les personnes atteintes de SDRCf présentent des caractéristiques particulières.Méthodes: Des recherches ont été effectuées dans les bases de données CINAHL, Medline, PsychINFO et PubMed, sans limite de date. La qualité des rapports a été évaluée à l'aide de l'échelle du Scottish Intercollegiate Guidelines Network et des listes de vérification de l'Institut Joanna Briggs.Résultats: Huit études ont été incluses. Les relations familiales ont été définies comme toutes les relations immédiates (i.e. parents, frères ou soeurs), ou les parents consanguins. Une combinaison de participants pour lesquels les causes du SDRC étaient connues et inconnues ont été recrutés. Les études ayant fait partie de cette revue vont dans le sens de la possible existence d'un SDRCf, bien que cette constatation touchait moins de 25 % des personnes affectées. Les personnes souffrant d'un possible SDRCf présentaient des symptômes plus graves, un plus grand nombre de régions touchées, un pourcentage plus élevé de déclenchements spontanés et le déclenchement de la maladie à un plus jeune âge. Un rapport relatif de récurrence élevé, se situant à 5,6 (95 % IC, 3,0 à 9,8) chez les frères et soeurs, a été rapporté pour les personnes de moins de 50 ans. Aucune des études n'établissait de modèle d'héritabilité. L'explication la plus plausible pour l'héritabilité serait donc un modèle mutifactoriel dans lequel les effets cumulatifs des gènes et de l'environnement pourraient interagir.Conclusions: Les conclusions de cette revue systémaique vont dans le sens de l'existence possible du SDRCf; toutefois, toutes les études répertoriées ont eu recours à des devis non contrôlés comme des rapports de cas, des séries de cas et des études cas-témoins qui ne peuvent pas prouver le lien de causalité. D'autres études sont nécesaires pour révéler l'héritabilité et la structure génétique du SDRCf.

The Multidimensional Symptom Index: A new patient-reported outcome for pain phenotyping, prognosis and treatment decisions.

BACKGROUND: There are few patient-reported outcomes routinely used that capture frequency and interference of different pain-related symptoms on a single scale. The purpose of this study was to describe the development and initial validation of the new Multidimensional Symptom Index (MSI). METHODS: Items were generated from patient interviews of the experience of chronic pain. Health valuations were created from rankings of 82 healthy subjects for each of 120 symptom (×10) × frequency (×3) × interference (×4) combinations using preference-based health valuations (0-100). Ranks for each symptom combination were then used in scale scoring. A sample of 300 patients with acute or chronic pain subsequently completed the MSI and a battery of other tools. Exploratory (EFA) and Confirmatory (CFA) factor analyses were triangulated with theory to arrive at the factor structure. Convergent validity was tested against established measures. RESULTS: Health rankings resulted in scores of 0-12 for each of the 10 symptom types. Factor analyses revealed two factors: MSI Somatic Symptoms and MSI Non-Somatic Symptoms. The MSI also quantified number of symptoms experienced (/10), mean frequency (/3) and mean interference (/4). The indices showed appropriate associations with the established PROs. CONCLUSIONS: The MSI is a new symptom-focused PRO that allows patient phenotyping and may have value for screening, prognosis and evaluating change. SIGNIFICANCE: This article presents the development and psychometric properties of a new measure of pain and related symptom frequency and interference. This measure could aid clinicians in establishing clinically relevant pain phenotypes for screening, prognosis and treatment decisions.

Morbid hypocalcemia associated with phosphate enema in a six-week-old infant.

A 6-week-old premature infant who was born at 29 weeks of gestation presented to the emergency department with a several-hour history of stiffness and increased alarms on his apnea monitor at home. On arrival he was noted to have generalized seizures, apnea, and bradycardia. He was intubated and required cardiopulmonary resuscitation including chest compressions and medications. After stabilization he was transferred to the neonatal intensive care unit for further management. His initial laboratory tests revealed a serum calcium level of 2.4 mg/dL (normal range: 8.4-10.2 mg/dL) and a serum phosphorus level of 28.5 mg/dL (normal range: 2.4-4.5 mg/dL). During the first week of admission, the infant's mother reported that she had administered a full pediatric Fleets enema (CB Fleet Company Inc, Lynchburg, VA) to him. The infant was discharged after 12 days of hospitalization. Anticipatory guidance on the stool patterns and behavior of infants can prevent misconceptions about constipation that are especially prevalent in new parents. Proper management of constipation, should it arise, should be addressed with all parents at early well-child visits to avoid hazardous complications of treatments. hypocalcemia, seizures, premature infants, enema.

Central and peripheral effects of oxytocin administration in prairie voles (Microtus ochrogaster).

The present study examined the hypothesis that oxytocin (OT) may influence female sexual behavior in prairie voles (Microtus ochrogaster). The effectiveness of OT to induce sexual behavior was tested in ovariectomized females that were injected daily with estradiol benzoate (EB, 0.02 micrograms, twice), a dose insufficient for estrus induction. On the third day females received intracerebroventricular (ICV) injections of OT (1, 300, or 1000 ng) or saline vehicle. In the presence of minimal estrogen stimulation, OT did not induce sexual receptivity, or influence autogrooming or other social interactions. The behavioral effects of OT were examined in another group of ovariectomized females that received daily oil or EB injections (10 micrograms, twice) followed on the third day by either ICV (1, 300, or 1000 ng) or intraperitoneal (IP) (1, 3, or 10 micrograms) injections of OT. Among EB-treated females, only those in confirmed estrus, prior to ICV or IP injection, were included in these studies. There was a dose-related decrease in the percentage of females that remained in behavioral estrus after ICV OT. In those females that continued to show sexual behavior, lordosis frequencies and durations were unaffected by ICV OT. Nonsexual behavior did not differ between mated females and those exhibiting OT-inhibited sexual behavior. In females that were EB-treated, autogrooming and side-by-side behavior increased after ICV OT, while there was a decline in aggression. Female sexual and nonsexual behaviors were not significantly affected by IP OT.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of a metabolic disease, scurvy, by administration of the missing enzyme.

Reaction of immunoprecipitated L-gulonolactone oxidase with glutaraldehyde allows multiple administrations of large amounts of this enzyme extracted from either chicken or rats to guinea pigs. L-Gulonolactone oxidase converts L-gulonolactone to ascorbic acid, and its absence from guinea pigs and primates results in their requirement for this vitamin. By administration of this enzyme guinea pigs are able to survive on an ascorbic-acid-deficient regimen.

Glutaraldehyde-reacted immunoprecipitates of L-gulonolactone oxidase are suitable for administration to guinea pigs.

The potential pharmacologic use of enzymes has long been considered. Practical applications, however, have been limited by the toxicity and allergic response to administered foreign proteins. A simple in vitro modification that allows the intraperitoneal administration of large doses of L-gulonolactone oxidase to guinea pigs is described. The enzyme is precipitated by guinea pig antisera and reacted with glutaraldehyde (0.125%). The product is comparatively nontoxic in guinea pigs. Administration of this enzyme enables guinea pigs to synthesize ascorbic acid. Success of this approach may depend on reinforcement by the bifunctional reagent of the enzyme-antibody complex.