Does gabapentin provide benefit for patients with knee OA? A benefit-harm and cost-effectiveness analysis.

OBJECTIVE: Gabapentin can treat neuropathic pain syndromes and has increasingly been prescribed to treat nociplastic pain. Some patients with knee osteoarthritis (OA) suffer from both nociceptive and nociplastic pain. We examined the cost-effectiveness of adding gabapentin to knee OA care. METHOD: We used the Osteoarthritis Policy Model, a validated Monte Carlo simulation of knee OA, to examine the value of gabapentin in treating knee OA by comparing three strategies: 1) usual care, gabapentin sparing (UC-GS); 2) targeted gabapentin (TG), which provides gabapentin plus usual care for those who screen positive for nociplastic pain on the modified PainDETECT questionnaire (mPD-Q) and usual care only for those who screen negative; and 3) universal gabapentin plus usual care (UG). Outcomes included cumulative quality-adjusted life years (QALYs), lifetime direct medical costs, and incremental cost-effectiveness ratios (ICERs), discounted at 3% annually. We derived model inputs from published literature and national databases and varied key input parameters in sensitivity analyses. RESULTS: UC-GS dominated both gabapentin-containing strategies, as it led to lower costs and more QALYs. TG resulted in a cost increase of $689 and a cumulative QALY reduction of 0.012 QALYs. UG resulted in a further $1,868 cost increase and 0.036 QALY decrease. The results were robust to plausible changes in input parameters. The lowest TG strategy ICER of $53,000/QALY was reported when mPD-Q specificity was increased to 100% and AE rate was reduced to 0%. CONCLUSION: Incorporating gabapentin into care for patients with knee OA does not appear to offer good value.

Effectiveness of remote exercise programs in reducing pain for patients with knee osteoarthritis: A systematic review of randomized trials.

Objective: Remote knee osteoarthritis (OA) management programs are becoming more popular. This systematic review examined the efficacy of remote exercise programs for relieving pain in persons with knee OA. Design: We conducted a search of studies published between January 1st, 2013 to March 31st, 2021 in PubMed, Embase, and MEDLINE. We included randomized trials of patients with knee OA or chronic knee pain, studying interventions with an element of telehealth exercise management, and evaluating knee pain as an outcome. Interventions could include fully remote or both remote and in-person components. We excluded observational cohort studies, pilot studies, and studies with poor Physiotherapy Exercise Database (PEDro) scores. Two reviewers extracted pain data, consisting of mean differences from baseline and between groups, and compared them to minimum clinically important difference (MCID) thresholds. Results: We identified 1867 reports, of which eleven trials with a total of 1861 participants met inclusion criteria. Only one trial demonstrated a clinically meaningful change from baseline between groups. Four interventions were found to result in clinically meaningful improvements in pain from baseline. Conclusion: This review was limited by variability in outcome measures, intervention content, and comparators. One trial with an inactive control demonstrated clinically meaningful between group differences in pain. All four interventions demonstrating meaningful improvements from baseline included study-initiated communications to discuss and personalize remotely delivered exercise programs. More studies comparing fully or partially remote exercise programs with both active and inactive controls could help optimize the use of remote programs for management of knee OA pain.

Position and size of massa intermedia in Serbian brains.

BACKGROUND: Massa intermedia, a midline bar-shaped structure, connects two thalami across the third ventricle in 70-80% of healthy humans. It has become clinically important since its absence was comprehended as a midline malformation of the brain and brought in connection with schizophrenia indicating that some symptoms could be a consequence of disturbed neuron chains underlying the mechanisms of attention and processing of information. The aim of the investigation was to find out the incidence, position, and size of massa intermedia in the brains of the Serbian population. MATERIALS AND METHODS: Our investigation was performed on 41 brains of adult Serbian cadavers using a macro dissection method. RESULTS: Massa intermedia was present in 80.49% of cases, in 1 case it was double. In most of the cases it was located in the superior quadrants of the lateral wall of the third ventricle, the larger part being in the anterosuperior one. Some other combinations were also present. The horizontal diameter of the cross-section was larger than vertical and was not in correlation with the length of the third ventricle. The average cross-sectional area was 29.58 mm2, significantly larger in females. CONCLUSIONS: Massa intermedia is present in most of the investigated brains, usually connecting the anterior-superior quadrants of the lateral walls of the third ventricle. Different in shape and size its cross-section is a horizontal ellipse, significantly larger in females. The cross-sectional area and the size of the third ventricle are not in correlation.

Tumor size and karyometric variables in brain astrocytoma.

PURPOSE: To show any possible correlation of some karyometric variables with tumor size in patients with brain astrocytoma, in order to confirm karyometry as an objective histological method. PATIENTS AND METHODS: The study included 63 patients of different ages and both genders with brain astrocytoma histologically confirmed on the surgically removed material. In all patients maximal tumor excision was done, and all were postoperatively treated according to different therapeutic protocols. Tumor size (preoperative CT scan) was correlated with the duration of survival and the values of some karyometric tumor variables: area, density, maximal axis, mean axis, minimal axis, circumference, roundness, integrated optical density (IOD) and number of nuclei. RESULTS: Patients were separated into 3 groups according to the average tumor diameter. There were 34 cases of medium-sized tumors, 12 of small and 17 of large-sized tumors, and their respective survival was 83, 97 and 24 weeks. Patients with large tumors had statistically shorter survival compared to those with medium and small tumors (log-rank test, p=0.0122). Seven out of 9 examined karyometric variables were significantly related (p<0.05) to the tumor size: area, maximal axis, mean axis, minimal axis, circumference, roundness and IOD. CONCLUSION: Patients with larger tumors have shorter survival. The results of our morphometric analysis of the tumor cell nuclei, after correlation with CT findings, revealed that nuclear pleomorphism and larger nuclear size are associated with larger brain astrocytomas.

IShTAR: A test facility to study the interaction between RF wave and edge plasmas.

Existence of high electric fields near an RF antenna launcher causes a number of parasitic phenomena, such as arcing and impurity release, which seriously deteriorate the performance of an Ion Cyclotron Range of Frequencies (ICRF) heating scheme in fusion devices. Limited accessibility of the near antenna region in large-scale fusion experiments significantly complicates the associated experimental studies. The IShTAR test facility has been developed with the requirement to provide a better accessibility and diagnosability of plasmas in the direct vicinity of an ICRF antenna. The purpose of this work is to give a detailed description on the experimental setup and the available diagnostics. Furthermore, the paper will demonstrate the capability of the experiment to study phenomena near an ICRF antenna launcher which are relevant for large-scale fusion ion cyclotron resonance heating systems.

Polarization Stark spectroscopy for spatially resolved measurements of electric fields in the sheaths of ICRF antenna.

A multichannel spectroscopic diagnostic based on the Stark effect on helium lines was developed and implemented in IShTAR (Ion Cyclotron Sheath Test ARrangement) to measure the spatial distribution of electric fields across the radio frequency sheaths of the ion cyclotron antenna. Direct measurements of the DC electric fields in the antenna sheaths are an important missing component in understanding the antenna-plasma edge interactions in magnetically confined fusion plasmas since they will be used to benchmark theoretical models against real antenna operation. Along with the high-resolution Czerny-Turner monochromator and a detector with an intensifier, the hardware relies on the 2 chained set of linear-to-linear fiber bundles that provide seven optical channels capable of resolving an 8.4 mm region in the vicinity of the antenna's box. The diagnostic is supported with local helium gas puff, enabling it to operate in nonhelium plasmas. Spatially resolved electric field was measured for two discharge configurations, one with and one without the ICRF antenna. The results show a clear difference in the shape of the DC electric field's spatial profile for the two cases studied, with the elevated values when the ICRF antenna was operating. This demonstrates the ability of the diagnostic to measure even small relative changes in the intensity of the electric field.

Development of a spectroscopic diagnostic tool for electric field measurements in IShTAR (Ion cyclotron Sheath Test ARrangement).

IShTAR, Ion cyclotron Sheath Test ARrangement, is a linear device dedicated to the investigation of the edge plasma-ICRF (Ion Cyclotron Range of Frequencies) antenna interactions in tokamak edge-like conditions and serves as a platform for a diagnostic development for measuring the electric fields in the vicinity of ICRF antennas. We present here our progress in the development of an optical emission spectroscopy method for measuring the electric fields which concentrates on the changes in the helium spectral line profiles introduced by the external electrical field, i.e., the Stark effect. To be able to fully control the operating parameters, at the first stage of the study, the measurements are conducted on a planar electrode installed in the centre of the plasma column in IShTAR's helicon plasma source. At the second stage, the measurements are performed in the vicinity of IShTAR's ICRF antenna.

Treating cat allergy with monoclonal IgG antibodies that bind allergen and prevent IgE engagement.

Acute allergic symptoms are caused by allergen-induced crosslinking of allergen-specific immunoglobulin E (IgE) bound to Fc-epsilon receptors on effector cells. Desensitization with allergen-specific immunotherapy (SIT) has been used for over a century, but the dominant protective mechanism remains unclear. One consistent observation is increased allergen-specific IgG, thought to competitively block allergen binding to IgE. Here we show that the blocking potency of the IgG response to Cat-SIT is heterogeneous. Next, using two potent, pre-selected allergen-blocking monoclonal IgG antibodies against the immunodominant cat allergen Fel d 1, we demonstrate that increasing the IgG/IgE ratio reduces the allergic response in mice and in cat-allergic patients: a single dose of blocking IgG reduces clinical symptoms in response to nasal provocation (ANCOVA, p = 0.0003), with a magnitude observed at day 8 similar to that reported with years of conventional SIT. This study suggests that simply augmenting the blocking IgG/IgE ratio may reverse allergy.

Peritumoral edema and karyometric variables in astrocytoma of the brain.

PURPOSE: The aim of this study was to evaluate karyometry as a quantitative and objective histological method by showing correlation of some karyometric variables with the severity of peritumoral edema in patients with brain astrocytoma. PATIENTS AND METHODS: 63 patients of different ages and both genders were enrolled. The patients were diagnosed with astrocytoma of the brain, histologically confirmed on the surgically removed material. Maximal tumor excision was performed in all patients, who were postoperatively treated according to current oncologic therapeutic protocols. The intensity of perifocal edema (preoperative CT scan) was correlated to the duration of survival and the values of 9 karyometric tumor variables: area, density, maximal axis, mean axis, circumference, roundness, integrated optical density and number of nuclei. RESULTS: There were 17 cases with small perifocal edema, 19 with medium-sized and 27 with large perifocal edema, and their respective survival was around 149, 62 and 48 weeks. Those with small edema had statistically significant prolonged survival compared to those with medium and large perifocal edema (log-rank test, p=0.045). Six out of 9 karyometric variables examined were significantly related (p<0.05) to the intensity of peritumoral edema: long and mean axis, circumference, roundness, integrated optical density and number of nuclei. CONCLUSION: Patients with larger peritumoral edema have shorter survival. Correlation of karyometric variables with CT findings revealed that higher degrees of tumor cellularity and nuclear wrinkling with increased integrated optical density is associated with larger peritumoral edema.

Low-constraint facilitation in lexical decision with single-word contexts.

Single-word, low-constraint adjective contexts were used to "prime" lexical decision to noun targets in Serbo-Croat. Semantically congruent situations consisted of adjective-noun pairs that were not highly predictable but were nonetheless plausible (e.g., GOOD-AUNT). Semantically incongruent situations used pairs that were implausible (e.g., SLOW-COAT). All adjective-noun pairs were grammatically congruent and were compared with a neutral XXX baseline. In Experiment 1, at a stimulus onset asynchrony of 300 ms, congruous situations showed 59 ms of facilitation while incongruous situations did not differ from the baseline. The same pattern was repeated in Experiment 2, at a stimulus onset asynchrony of 800 ms. Congruous situations were facilitated 67 ms. Results are discussed in terms of a message-level coherence check in Forster's (1979) model of autonomous levels of language processing.

[Natural course of the arteriovenous malformations of the brain].

Arteriovenous cerebral malformations represent congenital malformations. Considering the anatomical characteristics of the cerebral angiomas and their localization, in a great number of cases they demand a combined therapeutic approach--surgery, embolization and radiotherapy. Besides the constant progress of technology, 5% of all cerebral angiomas can not be completely excluded from the circulation. Therefore, the need to understand their natural course became a necessity. Our results point to the fact that they are vascular malformations of a considerably more benign clinical course than the aneurysms. Our clinical model points to an annual risk of hemorrhage which is 3.3% with total mortality of 5.3%, especially if the size of the angioma is 2.5-5 cm, localized in the motor zone of the brain, with combined type of vein drainage and arterial supply from the vertebrobasilary confluence. Epilepsy caused by the cerebral angioma is in 26.7% refractory to medicamentous therapy and in 25% (every 4th patient) will have hemorrhage with an annual risk of 0.14%.