T4-like Escherichia coli phages from the environment carry blaCTX-M.

The resistance determinant blaCTX-M has many variants and has been the most commonly reported gene in clinical isolates of extended spectrum beta-lactamase producing Escherichia coli. Phages have been speculated as potential reservoirs of resistance genes and efficient vehicles for horizontal gene transfer. The objective of the study was to determine the prevalence and characterize bacteriophages that harbour the resistance determinant blaCTX-M . Escherichia coli specific bacteriophages were isolated from 15 samples including soil and water across Mangaluru, India using bacterial hosts that were sensitive to ß-lactams. Phenotypic and genotypic characterization based on plaque morphology, host range, restriction fragment length polymorphism (RFLP), presence of blaCTX-M and electron microscopy was performed. Of 36 phages isolated, seven were positive for Group 1 of blaCTX-M . Based on host range and RFLP pattern, the seven phages were classified into four distinct groups, each harbouring a variant of blaCTX-M . Five phages were T4-like Myoviridae by electron microscopy which was further confirmed by polymerase chain reaction (PCR) for T4 specific gp14. Generalized transduction of the CTX-M gene from these phages was also observed. The high prevalence (20%) of this gene blaCTX-M in the phage pool confirms the significant role of Myoviridae members, specifically T4-like phages in the dissemination of this resistance gene. SIGNIFICANCE AND IMPACT OF THE STUDY: The CTX-M gene that confers resistance to Beta-lactam class of drugs is widespread and diverse. Understanding mechanisms of antimicrobial resistance transfer is a key to devise methods for controlling it. Few studies indicate that bacteriophages are involved in the transfer of this gene but the type of phages involved and the degree of involvement remains to be explored. Our work has been able to identify the class of phages and the magnitude of involvement in the dissemination of this gene.

Opioid Use in Chronic Pain Patients with Chronic Kidney Disease: A Systematic Review.

OBJECTIVES: To investigate the prevalence of chronic pain and opioid management among patients with chronic kidney disease (CKD). DESIGN: Systematic review. METHODS: A systematic search was performed, including citations from 1960 to May 2015. The review highlights methodological quality assessment of the selected studies; prevalence of pain; type, dose, and reason for opioid use; effectiveness of pain control and associated adverse effects of opioids in CKD patients. RESULTS: Twelve of 131 articles met inclusion criteria. There were no randomized controlled trials (RCT) evaluable, and 12 were observational studies. Out of 12 studies, four were of high quality, six were of moderate quality, and the remaining two were low-quality studies. The studies were from different countries with sample size ranging from 10 to 12,782. Several studies showed a high prevalence of chronic uncontrolled pain. The effectiveness of different categories of opioids, dose, duration, and commonly prescribed opioids varied across studies. CONCLUSIONS: Based on a systematic review of the current literature, there is fair evidence for the high prevalence of chronic pain among patients with CKD, which is not being effectively managed, probably due to underprescription of analgesics or opioids in the CKD population. Clinicians are in need of additional and well-designed randomized control trials that focus on the indications for opioid therapy, appropriate opioid doses and dosing intervals, outcomes with adequacy of symptom control, and reporting on the incidence of adverse side effects.

Increased Incidence of Spinal Abscess and Substance Abuse after Implementation of State Mandated Prescription Drug Legislation.

OBJECTIVES: To investigate the incidence of spinal abscess and substance abuse in a tertiary care hospital after state legislation titled "House Bill 1" (HB1) mandated stricter regulation of prescription drugs of abuse in Kentucky in 2012. DESIGN: A retrospective case series study design was used to review the incidence of spinal abscess and drug abuse diagnoses admissions from 2010 to 2014. Variances in the incidence of spinal abscess and substance abuse were plotted across this time frame. RESULTS: The incidence of intraspinal abscess increased 1.56-fold in 2011 (n = 26) and 2012 (n = 25) relative to 2010 (n = 16). However, in 2013, the year following implementation of HB1 legislation, the incidence of intraspinal abscess increased 2.38-fold (n = 38) and then 4.19-fold (n = 67) in 2014. The incidence of intraspinal abscess in subjects with drug abuse diagnosis remained constant between 2010 (n = 3) and 2012 (n = 3). However, it increased twofold (n = 7) in 2013 and then ninefold (n = 27) in 2014. A correlation coefficient (rSAD ) of 0.775 revealed a strong association between the increase incidence of intraspinal abscess and diagnosis of drug abuse. CONCLUSIONS: The results of this retrospective study demonstrate an increased incidence of intraspinal abscess associated with drug abuse after passage of HB1 legislation regulating prescriptions of controlled medications in Kentucky. This increased incidence may be related to individuals relying on nonprescription drugs of abuse due to more highly regulated access to controlled prescription medications. However, additional factors unrelated to HB1 legislation must be taken into account.

Characterization and quantification of fungal colonization of Phakopsora pachyrhizi in soybean genotypes.

Soybean rust, caused by the fungus Phakopsora pachyrhizi, is an economically important disease of soybean with potential to cause severe epidemics resulting in significant yield losses. Host resistance is one of the management tools to control this disease. This study compared soybean genotypes exhibiting immunity, complete and incomplete resistance, and susceptibility to an isolate of P. pachyrhizi based on visual assessment of reaction type, other visual traits such as sporulation, quantitative measurements of the amount of fungal DNA (FDNA) present in leaf tissues, and data on infection and colonization levels. Soybean genotype UG5 (immune), and plant introduction (PI) 567102B and PI 567104B (complete resistance) had lower quantities of uredinia and FDNA than four other genotypes with incomplete resistance. Based on microscopic observations, early events of spore germination, appressorium formation, and fungal penetration of the epidermis occurred within 24 h postinoculation and were similar among the tested soybean genotypes. Differences in infection among the genotypes were evident once the hyphae penetrated into the intercellular spaces between the mesophyll cells. At 2 days after inoculation (dai), soybean genotype Williams 82 had a significantly (P < 0.05) higher percentage of hyphae in the mesophyll tissue than other soybean genotypes, with UG5 having significantly (P < 0.05) lower percentages than all of the other soybean genotypes at 3, 4, and 5 dai. The percentage of interaction sites with mesophyll cell death was significantly (P < 0.05) higher in UG5 than other genotypes at 3, 4, and 5 dai. There was a significant positive correlation (r = 0.30, P < 0.001) between quantities of hyphae in the mesophyll cells and FDNA. These results demonstrated that incompatible soybean-P. pachyrhizi interaction results in restricted hyphal development in mesophyll cell tissue, likely due to hypersensitive apoptosis.

A multiplexed immunofluorescence method identifies Phakopsora pachyrhizi Urediniospores and determines their viability.

Soybean rust, caused by Phakopsora pachyrhizi, occurs concomitantly wherever soybean is grown in the tropical and subtropical regions of the world. After reports of its first occurrence in Brazil in 2001 and the continental United States in 2004, research on the disease and its pathogen has greatly increased. One area of research has focused on capturing urediniospores, primarily by rain collection or wind traps, and detecting them either by microscopic observations or by immunological or molecular techniques. This system of detection has been touted for use as a potential warning system to recommend early applications of fungicides. One shortcoming of the method has been an inability to determine whether the spores are viable. Our study developed a method to detect viable P. pachyrhizi urediniospores using an immunofluorescence assay combined with propidium iodide (PI) staining. Antibodies reacted to P. pachyrhizi and other Phakopsora spp. but did not react with other common soybean pathogens or most other rust fungi tested, based on an indirect immunofluorescence assay using fluorescein isothiocyanate-labeled secondary antibodies. Two vital staining techniques were used to assess viability of P. pachyrhizi urediniospores: one combined carboxy fluorescein diacetate (CFDA) and PI, and the other utilized (2-chloro-4-[2,3-dihydro-3-methyl-(benzo-1,3-thiazol-2-yl)-methylidene]-1-phenylquinolinium iodide] (FUN 1). Using the CFDA-PI method, viable spores stained green with CFDA and nonviable spores counterstained red with PI. Using the FUN 1 method, cylindrical intravacuolar structures were induced to form within metabolically active urediniospores, causing them to fluoresce bright red to reddish-orange, whereas dead spores, with no metabolic activity, had an extremely diffused, faint fluorescence. An immunofluorescence technique in combination with PI counterstaining was developed to specifically detect viable P. pachyrhizi urediniospores. The method is rapid and reliable, with a potential for application in forecasting soybean rust based on the detection of viable urediniospores.

Neutralizing IL-17 prevents obliterative bronchiolitis in murine orthotopic lung transplantation.

Obliterative bronchiolitis (OB) is the key impediment to the long-term survival of lung transplant recipients and the lack of a robust preclinical model precludes examining OB immunopathogenesis. In the current study, lungs from C57BL/10 H-2(b) mice that are MHC compatible, but minor histocompatability antigen incompatible, were transplanted into C57BL/6 mice. Histological features and cytokine profiles of OB were assessed. Moderate rejection (grade A3) developed by day 14, with evidence of OB at that time point. At 21 days, OB was present in 55% of grafts and moderate to severe rejection (grade A3-A4) was present in all mice. At 28 days, OB was present in 44% of mice and severe rejection (grade A4) was present in all. IL-17A, but not IL-17F, splenic mRNA transcripts and serum protein levels were increased only in mice that developed OB, whereas IL-10 transcripts and protein were increased only in non-OB mice. Neutralizing IL-17 prevented OB, down regulated acute rejection, and upregulated systemic IL-10. Collectively, these data show that transplantation of minor histoincompatible lungs from C57BL/10 mice into C57BL/6 mice results in a highly reproducible preclinical model of OB. In addition, these data indicate that neutralizing IL-17A or augmenting IL-10 could be therapeutic interventions to prevent OB.

Synthesis of hexagonal ZnO clubs with opposite faces of unequal dimensions for the photoanode of dye-sensitized solar cells.

Novel sub-micro sized hexagonal clubs of ZnO (HC-ZnO), which are coated as a scattering layer (SL) for the photoanode of a DSSC, are synthesized. X-ray diffraction (XRD) patterns of the ZnO clubs show clear peaks corresponding to wurtzite crystal phase of ZnO. Scanning electron microscopic (SEM) images show that each club has two opposite hexagonal faces (parts) of unequal dimensions. High resolution transmission electron microscopic (HR-TEM) image of a single ZnO club reveals that the ZnO is single crystalline and has wurtzite crystal structure; the image indicates a lattice spacing (d) of 0.26 nm; this is ascribed to the (002) planar spacing of the hexagonal ZnO. A solar-to-electricity conversion efficiency (η) of 3.36% is achieved for the cell with the double layer (DL) film, which is 16% higher than that of the cell with only transparent layer (TL) of commercial ZnO (2.89%) and far higher than that of the cell with SL (0.05%). The η of the cell with the DL (3.36%) could further be improved to 4.28% through the modification of the DL surface with TiO(x). Incident photo-to-current conversion efficiency (IPCE) curves, UV-vis absorption spectra, energy dispersive X-ray (EDX) spectra, and electrochemical impedance spectra (EIS) are also used to substantiate the results.

Enhanced performance of a dye-sensitized solar cell with the incorporation of titanium carbide in the TiO2 matrix.

The effects of incorporation of various weight percentages of titanium carbide (TiC) into TiO(2) matrices on the photovoltaics of the respective dye-sensitized solar cells (DSSCs) were investigated. It is established through relevant photographs, XRD and EDX analysis that TiC was partially converted into anatase TiO(2) (a-TiO(2)) when the TiC was sintered at 450 degrees C. With the incorporation of 3.0 wt% of the TiC in the TiO(2) film, the solar-to-electricity conversion efficiency (eta) of the cell reached 7.56% from its value of 6.61% with a bare TiO(2) film. "In situ" incorporation of this TiC/a-TiO(2) composite in the commercial TiO(2) is considered as the basis for enhanced cell efficiency of the benefited cell. The variations in J(SC), FF, and V(OC) are explained by analyzing the data of dark currents, UV-absorption spectra, transparency spectra, and electrochemical impedance spectra (EIS) which were obtained under illumination and darkness. Enhancement in the V(OC) for the promoted cell is explained through pertinent electron lifetime in the TiO(2) film, which was obtained by using laser-induced photo-voltage transient studies. Electron diffusion coefficient was also measured by using laser-induced photo-current transient studies.

Transparent Cobalt Selenide/Graphene Counter Electrode for Efficient Dye-Sensitized Solar Cells with Co2+/3+-Based Redox Couple.

In this study, we demonstrate a facile, one-pot, and low-temperature (∼85 °C) chemical bath method for the preparation of a composite of cobalt selenide/graphene (Co0.85Se/Gr) as the electrocatalyst for the counter electrode (CE) of dye-sensitized solar cells (DSSCs) with a cobalt-based electrolyte. The Co0.85Se/Gr composite film was envisaged to have the advantages of both components, that is, the high electrochemical surface area of Co0.85Se and the straight paths for electron transfer from Gr. The DSSCs with Co0.85Se/Gr exhibited a power conversion efficiency (η) of 11.26%. According to the results of the rotating disk electrode, the film of Co0.85Se/Gr showed a high electrocatalytic surface area (Ae) and an extremely large intrinsic heterogeneous rate constant (k0). Furthermore, the composite film of Co0.85Se/Gr exhibits a high transparency in the wavelength region of 400-800 nm (>82%), which implied that the corresponding electrode shall be a potential CE in rear-side illuminated DSSCs. The photovoltaic parameters of the DSSCs with Pt, Co0.85Se, Gr, and Co0.85Se/Gr were obtained for rear-side illumination and additionally for front- and rear-side illuminations (AM 1.5, 100 mW/cm2) using different electrolytes. As the cobalt-based electrolyte of [Co(bpy)3]2+/3+ exhibited a low light absorption and low overpotential for dye regeneration, a rear-side illuminated DSSC with a cobalt-based electrolyte showed the highest efficiency of 9.43 ± 0.02%, which is greater than that of the DSSC with an I-/I3--based electrolyte (η = 7.63 ± 0.04%).

CTAB-promoted prussian blue-modified electrode and its cation transport characteristics for K+, Na+, Li+, and NH4+ ions.

A Prussian blue (PB) film was deposited on a glassy carbon (GC) electrode by cyclic voltammetry in the presence of the cationic surfactant cetyltrimethylammonium bromide (CTAB). The electrode thus formed showed 4-fold enhancements in redox current and charge values in pure KCl electrolyte as well as greater stability than an electrode prepared in the absence of CTAB. This improved performance of a PB+CTAB electrode versus a PB electrode was further demonstrated using SEM, XRD, and electrochemical impedance spectroscopy (EIS) measurements. A comparative study was undertaken on the cation transport characteristics of PB and PB+CTAB electrodes for Na+, Li+, and NH4+ ions. We obtained a CV pattern for a CTAB-promoted PB film, which showed ideal Nernstian behavior at all scan rates from 5 to 140 mV s(-1). Conditions for the formation and preservation of these ideal and stable PB films are discussed. Possible mechanisms for the beneficial effects of CTAB are proposed.

Rehabilitation Outcomes in Spinal Abscess Patients With and Without a History of Intravenous Substance Abuse.

OBJECTIVE: The aim of the study was to compare functional outcomes of acute inpatient rehabilitation for spinal epidural abscess patients with and without history of intravenous substance abuse. DESIGN: This is a retrospective case series study in freestanding rehabilitation hospital. METHODS: Charts of 28 spinal epidural abscess patients admitted from January 2012 to September 2015: 13 with intravenous substance abuse and 15 without intravenous substance abuse were reviewed. Both groups received standard-of-care rehabilitation. Statistical analyses of Functional Independence Measure scores were conducted using individual 2 (substance use) × 2 (rehabilitation status) repeated measures analysis of variance. Functional outcomes were defined by total Functional Independence Measure scores as well as motor and cognitive subsets. Length of stay and morphine equivalents were also compared. RESULTS: There were no significant differences between the two groups. There was a significant main effect of treatment on total Functional Independence Measure scores (P < 0.001), Functional Independence Measure motor scores (P < 0.001), and Functional Independence Measure cognitive scores (P < 0.01) from admission to discharge. Subsequent Student's t tests revealed that the scores of both groups significantly improved on all Functional Independence Measure components. There were no group differences on length of stay and morphine equivalents at discharge. CONCLUSIONS: Acute inpatient rehabilitation can effectively improve functional outcomes in spinal epidural abscess patients with or without intravenous substance abuse, even though these two patient groups can vary in clinical factors.

The Effect of Current Low Back Pain on Volitional Preemptive Abdominal Activation During a Loaded Forward Reach Activity.

BACKGROUND: A volitional preemptive abdominal contraction (VPAC) supports trunk stability during functional activity. Pain-free individuals can sustain VPAC during function, but such has not been reported for individuals with current low back pain (cLBP). OBJECTIVE: To examine whether cLBP affects VPAC performance during a loaded forward reach (LFR) task. DESIGN: Observational crossover study. SETTING: Laboratory. PARTICIPANTS: A total of 18 controls and 17 subjects with cLBP with pain ratings of 1/10 to 4/10 on a visual analog scale. INTERVENTIONS: Transverse abdominis (TrA) thickness measurements were recorded by blinded researchers from M-mode ultrasound imaging during 4 conditions: (1) quiet standing without abdominal drawing-in maneuver (ADIM); (2) quiet standing with ADIM; (3) LFR without ADIM; and (4) LFR with ADIM. A physical therapist with 29 years of experience collected historical and examination data. MAIN OUTCOME MEASURES: TrA muscle thickness (mm). RESULTS: A 2 (group) × 2 (contraction) × 2 (reach) analysis of variance demonstrated a significant group × contraction interaction (F [1, 31] = 4.499, P = .04) where ADIM produced greater TrA thickness increases in PLBP subjects (2.18 mm) versus controls (1.36 mm). We observed a significant main effect for reach (F [1, 31] = 14.989, P < .001), where LFR activity produced a greater TrA thickness (6.15 ± 2.48 mm) versus quiet standing (5.30 ± 2.12 mm). CONCLUSIONS: Subjects with cLBP demonstrated a greater increase in TrA activation during ADIM versus controls.

Linkage of N3 dye to N3 dye on nanocrystalline TiO2 through trans-1,2-bis(4-pyridyl)ethylene for enhancement of photocurrent of dye-sensitized solar cells.

Linking of N3 dye to another TiO2-attached N3 dye rendered an enhanced short-circuit photocurrent and thereby higher efficiency for the dye-sensitized solar cell with the pertinent TiO2 film electrode.

Beneficial role of surfactants in electrochemistry and in the modification of electrodes.

This review deals with the beneficial use of surfactants in various fields of electrochemistry, in general and in the modification of electrodes with immobilized electroactive species, in particular. Special emphasis is laid on the modification of electrodes with metal hexacyanoferrates (MHCFs). After an introduction and brief notes on fundamentals of surfactants, and their applications in electrochemistry, covering some of the very important works in the past two decades involving beneficial use of surfactants, the article gives a brief account on metal hexacyanoferrate modified electrodes and the salient features of our published results on the beneficial role of cetyltrimethylammonium bromide (CTAB), a cationic surfactant, in the modification of electrodes with MHCFs and their derivatized oxides, and with titanium dioxide.

Multifunctional Iodide-Free Polymeric Ionic Liquid for Quasi-Solid-State Dye-Sensitized Solar Cells with a High Open-Circuit Voltage.

A polymeric ionic liquid, poly(oxyethylene)-imide-imidazolium selenocyanate (POEI-IS), was newly synthesized and used for a multifunctional gel electrolyte in a quasi-solid-state dye-sensitized solar cell (QSS-DSSC). POEI-IS has several functions: (a) acts as a gelling agent for the electrolyte of the DSSC, (b) possesses a redox mediator of SeCN(-), which is aimed to form a SeCN(-)/(SeCN)3(-) redox couple with a more positive redox potential than that of traditional I(-)/I3(-), (c) chelates the potassium cations through the lone pair electrons of the oxygen atoms of its poly(oxyethylene)-imide-imidazolium (POEI-I) segments, and (d) obstructs the recombination of photoinjected electrons with (SeCN)3(-) ions in the electrolyte through its POEI-I segments. Thus, the POEI-IS renders a high open-circuit voltage (VOC) to the QSS-DSSC due to its functions of b-d and prolongs the stability of the cell due to its function of a. The QSS-DSSC with the gel electrolyte containing 30 wt % of the POEI-IS in liquid selenocyanate electrolyte exhibited a high VOC of 825.50 ± 3.51 mV and a high power conversion efficiency (η) of 8.18 ± 0.02%. The QSS-DSSC with 30 wt % POEI-IS retained up to 95% of its initial η after an at-rest stability test with the period of more than 1,000 h.

The Effect of Distractive Function on Volitional Preemptive Abdominal Contraction During a Loaded Forward Reach in Normal Subjects.

BACKGROUND: Volitional preemptive abdominal contraction (VPAC) is used to protect the spine and prevent injury. No published studies to data have examined the effect of distraction on VPAC use during function. OBJECTIVE: To examine the effect of an auditory distraction ("Stroop task") on healthy subjects' ability to sustain VPAC by use of the abdominal drawing-in maneuver during loaded forward reach. DESIGN: Within-subjects, repeated-measure cohort design. SETTING: Clinical laboratory setting. PARTICIPANTS: Convenience sample of 42 healthy individuals (ages 20-57 years). METHODS: Transversus abdominis (TrA) thickness was measured with M-mode ultrasound imaging. Each subject performed Stroop versus no Stroop during 4 conditions: (1) without VPAC, quiet standing; (2) with VPAC, quiet standing; (3) without VPAC, forward reach; and (4) with VPAC, forward reach. An investigator blinded to the conditions measured the first 10 subjects to establish intratester reliability of probe/transducer placement and TrA measurement. DATA REDUCTION: TrA thickness (mm) change represented VPAC performance. A single investigator measured onscreen TrA thickness twice at each second from second-6 through -10 on a recorded ultrasound imaging sequence. RESULTS: A 2 (Stroop) × 4 (Activity) repeated-measures analysis of variance found no significant Stroop × Activity interaction [F(3, 93) = 0.345, P = .793] and no main effect for Stroop [F (1,31) = 1.324, P = .259] but found a significant main effect for activity [F (3,93) = 17.729, P < .001]. Tukey post-hoc pairwise comparisons demonstrated significant differences between VPAC versus no-VPAC conditions, except between quiet standing/yes-VPAC and loaded forward reach/no-VPAC conditions (P = .051). The interclass correlation coefficient (3,2) for probe/transducer placement reliability was 0.87, 0.91, 0.92, and 0.93 for conditions 1-4, respectively. The interclass correlation coefficient (3,2) for TrA measurement reliability was 0.96, 0.99, 0.99, and 0.99 for conditions 1-4, respectively. CONCLUSION: A distracting executive function (Stroop task) did not produce a significant negative impact on normal individuals' ability to sustain a VPAC during quiet standing or loaded forward reach activities. LEVEL OF EVIDENCE: II.

Implications of bariatric surgery on chronic pain and opioid use.

Questions from patients about pain conditions, pain treatment, and responses from authors are presented to help educate patients and make them effective self-advocates. The topics addressed in this report are implications of bariatric surgery or weight loss surgery on chronic pain and opioid use, what to expect with regards to pain control, and the need to change opioid dose after bariatric surgery.

Chronic opioid pain management for chronic kidney disease.

Questions from patients about pain conditions, pain treatment, and responses from authors are presented to help educate patients and make them effective self-advocates. The topics addressed in this issue are renal or kidney failure and chronic pain management with opioids, morphine, and oxycodone effect in the body over a period of time. This includes process of absorption, distribution, localization in tissues, biotransformation and excretion in chronic kidney disease, expected side effects and recommendations.

Hypogonadism associated with long-term opioid therapy: A systematic review.

BACKGROUND: Sexual dysfunction and Opioid-Induced Sexual Hormone Deficiency (OPISHD) have been associated with patients on long-term opioid pain therapy. There have been few comprehensive reviews to establish a relation between hypogonadism with chronic opioid pain management. The OPISHD is often not treated and literature guiding this topic is scarce. OBJECTIVE: To investigate hypogonadism associated with long-term opioid therapy based on qualitative data analysis of the available literature. STUDY DESIGN: Systematic review. INTERVENTIONS: The review included relevant literature identified through searches of PubMed, Cochrane, Clinical Trials, US National Guideline Clearinghouse, and EMBASE, for the years 1960 to September 2013. The quality assessment and clinical relevance criteria used were the Cochrane Musculoskeletal Review Group Criteria for randomized control trials and the Newcastle-Ottawa Scale Criteria for observational studies. The level of evidence was classified as good, fair, and poor, based on the quality of evidence. MAIN OUTCOME MEASURES: The primary outcome measures were clinical symptoms and laboratory markers of hypogonadism. Secondary outcome measure was management of OPISHD. RESULTS: Thirty-one studies were identified, of which 14 studies met inclusion criteria. There were no randomized control trials and eight of 14 studies were of moderate quality. The remaining studies were of poor quality. Four studies report most patients on long-term oral opioid therapy have associated hypogonadism and three studies of patients receiving intrathecal opioid therapy suggest that hypogonadism is common. CONCLUSIONS: There is lack of high-quality studies to associate chronic opioid pain management with hypogonadism. At present, there is fair evidence to associate hypogonadism with chronic opioid pain management, and only limited evidence for treatment of OPISHD.

Systematic review of radiofrequency ablation and pulsed radiofrequency for management of cervicogenic headache.

BACKGROUND: Cervicogenic headache is a secondary headache that has a source in the upper cervical spine. There is a small but growing body of evidence to establish effectiveness of radiofrequency (RF) neurotomy, and the pulsed RF (PRF) procedure for management of cervicogenic headache. OBJECTIVE: To investigate the clinical utility of RF neurotomy, and PRF ablation for the management of cervicogenic headache. STUDY DESIGN: Systematic review. METHODS: The review included relevant literature identified through searches of PubMed, Cochrane, Clinical trials, U.S. National Guideline Clearinghouse and EMBASE from 1960 to January 2014.The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria for randomized control trials and the Newcastle-Ottawa Scale criteria for observational studies. The level of evidence was classified as good, fair, and poor based on the quality of evidence. OUTCOMES MEASURED: The primary outcome measures were reduction in pain scores and improvement in quality of life. RESULTS: The primary outcome measures were headache relief and improved quality of life. Twenty five studies were identified for full text review of these, 9 studies met inclusion criteria. There were 5 non-randomized, among them 4/5 were of moderate quality, 3/5 showed RF ablation and 1/5 showed PRF as an effective intervention for cervicogenic headache. There were 4 randomized trials among them 2/4 were of high quality, 3/4 investigated RF ablation as an intervention for CHA, 1/4 investigated PRF ablation as an intervention for CHA and none of the randomized studies showed strong evidence for RF and PRF ablation as an effective intervention for CHA. LIMITATIONS: In the selected studies there were inconsistencies between randomized trials, flaws in trial design, and gaps in the chain of evidence. CONCLUSION: There is limited evidence to support RF ablation for management of CHA as there are no high quality RCTs and/ or multiple consistent non-RCTs without methodological flaws. There is poor evidence to support PRF for CHA as there are no high quality RCTs or Non-RCTs.