Rejected

: Self-perceived burden and perceived burdensomeness are two apparently related constructs that have arisen independently from research in physical and mental health, respectively. Although both are associated with suicidal ideation in individuals with chronic pain, they have yet to be examined concurrently in the same group of patients. : The aim of this study was to investigate the relationship between the two constructs and their differential prediction of suicidal ideation. : Participants were 260 outpatients of an interdisciplinary chronic pain treatment program. Each participant completed the Self-Perceived Burden Scale (SPBS), the Interpersonal Needs Questionnaire Perceived Burdensomeness Scale (INQPBS), the Beck Scale for Suicide Ideation, and the thoughts of self-harm item of the Patient Health Questionnaire-9. : The SPBS and the INQPBS were both unifactorial measures with good internal consistency. They correlated significantly with one another ( = 0.50,  < 0.001), as well as with scores on the two measures of suicidal ideation (s ranging from 0.29 to 0.62, s < 0.001). However, the INQPBS correlated more highly with suicidal ideation than did the SPBS. In regression analyses, the INQPBS predicted unique variance in suicidal ideation after adjusting for the SPBS. Conversely, the SPBS did not contribute uniquely when the INQPBS was entered first. : Patients with chronic pain who believe that they have become "a burden to others" are at increased risk for suicidal ideation. The conceptual similarities and differences between the constructs of self-perceived burden and perceived burdensomeness are reviewed to explain why perceived burdensomeness is the stronger predictor of this increased risk.

Long noncoding RNA (lncRNA) and factors influencing lncRNA expression are related to the nervous system diseases. The aims of the project are to study the effect of lncRNA uc.48+ siRNA on calcitonin gene related peptide (CGRP) release in the spinal cords (SCs) of diabetic neuropathic pain (DNP) rats to identify its possible mechanism and to provide new experimental evidence for the prevention and treatment of DNP. Male Sprague-Dawley rats were used to create a DNP rat model by feeding the rats a high-fat and fructose diet in addition to an intraperitoneal injection of streptozocin. Fasting blood glucose (FBG), mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL) were measured to select the DNP rats. The DNP rats were randomly divided into the following 4 groups: (1) a normal control group (Control), (2) a DNP rats treated with saline group (DNP), (3) a DNP rats treated with uc.48+ siRNA group (DNP + uc.48+ siRNA) and (4) a DNP rats treated with scrambled siRNA group (DNP + scramble siRNA). After intrathecal injection of uc.48+ small interfering RNA, the MWT and TWL of the DNP group significantly decreased compared to the Control group, but after the injection of uc.48+ small interfering RNA, the MWT and TWL of the DNP rats significantly increased (P<0.01, ANOVA test). The application of the methods of qPCR and WB produced results that revealed that the expressions of lncRNA uc.48+, CGRP, IL-1β and TNF-α in the SCs of the DNP group were much higher than those in the Control group (P<0.01, ANOVA test), but the expressions of these molecules in the DNP + uc.48+ siRNA group significantly decreased compared with the DNP group (P<0.01, ANOVA test). The phosphorylations of p38 and ERK1/2 in the DNP group were significantly enhanced compared with the Control group, whereas uc.48+ siRNA significantly reduced the increased phosphorylations of p38 and ERK1/2 pathway in the SCs of the DNP rats (P<0.01, ANOVA test). ELISA results revealed that uc.48+ siRNA significantly decreased the high levels of IL-1β and TNF-α in the sera of the DNP rats (P<0.01, ANOVA test). Therefore, lncRNA uc.48+ may play an important role in the transmission of DNP by promoting the release of CGRP in the SC. Small interfering lncRNA uc.48+ might alleviate the hyperalgesia and allodynia of DNP rats by suppressing the release of CGRP in the SCs of DNP rats, which might inhibit the phosphorylations of p38 and ERK1/2 and suppress the release of IL-1β and TNF-α in the SCs of DNP rats.

: Mild traumatic brain injury (mTBI) often results in post-concussion symptoms, chronic pain, and sleepiness. Genetic factors are thought to play an important role in poor prognosis. : The aims of this study are to (1) document the prevalence of pain and post-concussion symptoms in mTBI patients in acute and chronic phases (2) determine whether candidate genes predispose to post-concussive symptoms and pain. : Posttraumatic symptoms, evaluated using the Rivermead Post-Concussion Symptoms Questionnaire, and pain were assessed in 94 mTBI patients in the acute phase as well as in 22 healthy controls. Assessment was repeated in 36 patients after one year who agreed to participate in the follow-up visit. Gene polymorphisms and expression were assessed in mTBI patients and healthy controls. : In the acute phase, mTBI patients with pain (69%) presented more psychological symptoms and sleepiness and were less able to return to work than those without pain. At one year, 19% of mTBI patients had persistent pain and psychological distress. Two haplotypes (H2 and H3) in the brain-derived neurotrophic factor () gene were shown to be respectively deleterious and protective against post-concussion symptoms and pain in both acute and chronic phases. Protective haplotype H3 was associated with a decreased expression of the anti-sense of (). Deleterious haplotype H2 predicted the development of chronic pain at one year, whereas H3 was protective. : This pilot study suggests a protective mechanism of a multilocus effect in , through , against post-concussion symptoms and pain in the acute phase and possibly chronic pain at one year post-mTBI. The role of antisense RNA should be validated in larger cohorts.

Glioblastoma multiforme (GBM) is the most common and aggressive primary intracranial tumor. The tumor metastases outside the CNS are rare, so therapeutic experience with these types of tumors is limited. We present a case of a 20-year-old female with a history of left temporal anaplastic oligoastrocytoma, who was found to have biopsy proven metastases tothe lung. In April 2014, the patient presented with intermittent headache for 4 months. Physical examinations confirmed no obvious abnormalities. Computed tomography (CT) scan and magnetic resonance image (MRI) scan of the brain showed a large mass with ring-like enhancement in left temporal lobe. She underwent craniotomy to resect the intracranial tumor. Thepathological investigation showed the lesion to be a classical anaplastic oligoastrocytoma with focal necrosis and a Ki-67 labeling index of 10-30%. After operation, the patient received radiotherapy and chemotherapy. Two years later, the patient readmitted due to chest discomfort, a chest X-ray and CT showed a mass in the right lung. The lesion was confirmed to be a metastatic malignant glioma viapulmonary bronchoscopy biopsy. In conclusion, as the life expectancy is gradually increasing for GBM patients with newer therapies, the incidence of extracranial metastases may increase and this rare phenomenon may become more common and clinically relevant.

: Chronic scrotal pain (CSP) is a common and often debilitating condition found in up to 4.75% of men. There is little written on the impact of CSP on men's lives. : The aim of this study was to understand the impact of CSP on men's lives. : Patients with CSP were prospectively asked to complete a comprehensive questionnaire, including questions on quality of life (QoL), activities, and mood. : The mean age of the 131 patients was 43 years. Pain was intermittent, with severe pain episodes (mean pain scores 7.2 ± 2 out of 10) affecting men on average 40% ± 30% of the time. Overall, 88/131 (67.17%) of patients responded that they felt "unhappy" or "terrible" with their present situation. More than 40% of patients complained of depressive symptoms more than half the days of the month. Normal activities were adversely affected, with 68/131 (51.90%) reporting limited ability to work, 93/131 (70.99%) patients reporting decreased physical activity, and 81/131(61.83%) reporting decreased sexual activity. Comparing men with pain levels ≥ 7/10 vs. those with pain levels < 7/10, 47% (41/88) vs. 8.1% (3/37) reported that they felt "terrible," 40% (35/88) vs. 13% (5/38) had depressive feelings more than half the time, and 35% (28/80) vs. 16% (6/38) felt little pleasure doing things ( < 0.01 for all). : Our study suggests that QoL, mood, and the ability to perform normal activities are profoundly disturbed in CSP patients and that the pain severity is directly related to QoL.

Primary mucinous cystic tumors occurring in the renal pelvis or the entire pyelocaliceal system are uncommon. Most are mucinous cystadenomas and less frequently mucinous cystadenocarcinomas. In fact, the publications on these neoplasms are limited to a few cases. Because mucinous cystadenomas of kidney are exceedingly rare, little is known about their natural history, pathogenesis and clinicopathologic features. Herein, we describe 1 case of mucinous cystadenoma arising from the renal pelvis with calcification, which resembled hydronephrosis with renal calculus radiologically. The patient presented with a history of intermittent dull pain on the right waist since 10 years ago. He had no history of removing urinary calculus or long-standing chronic infection in urinary system. The histopathology was unique since the inner surface of the cyst was covered by a mucinous epithelium connected to a urothelium, a transition from nonneoplastic urothelium to mucinous epithelium was demonstrated by immunohistochemical staining for GATA-binding protein 3 (GATA3). This suggests that mucinous cystadenoma of renal pelvis, like its malignant counterpart, maybe arises in foci of metaplastic mucinous areas.

: Multidisciplinary pain clinics are considered the gold standard for the treatment of chronic pain, yet access to such clinics is difficult and patients' conditions deteriorate while waiting. Instituting a triage process is one way of reducing wait time for some patients and ensuring optimal access given the limited resources available. Surprisingly, there are no established guidelines on how to optimally triage chronic pain patients at tertiary multidisciplinary pain clinics. : The goal of this study was to gather information regarding existing triage systems in multidisciplinary chronic pain clinics worldwide as an initial step toward establishing a definitive evidence-based set of triage guidelines. : A total of 66 multidisciplinary pain clinics worldwide completed an online survey detailing current triage practices at their clinic. The survey was distributed via international and national pain associations. : Results showed that the vast majority of multidisciplinary pain clinics (94%) use a triage system, yet many difficulties with these systems have been identified (time requirement, administrative burden, lack of control over scheduling, missing high-priority patients, and prioritizing low-priority patients). The level of satisfaction was noted to be higher in those clinics using a structured triage template. : This study identified a need for the elaboration of best practice clinical guidelines for triage processes at tertiary pain clinics. The use of a structured referral template could become a central element to such guidelines.

Trigeminal neuralgia (TN) is one of the most intense forms of facial pain. It has been reported that the P2X receptor plays a crucial role in facilitating pain transmission, and the calcitonin-gene-related peptide (CGRP) from trigeminal ganglia (TGs) might perform differing function in nociceptive afferent input transmission. The present study investigated whether emodin can affect TN pain transmission by suppressing the expression of P2X receptors and CGRP in TGs. Chronic constriction injury of the infraorbital branch of the trigeminal nerve (CCI-ION) was used as TN model. The TN rats were randomly divided into the following 4 groups: (1) a sham group (Sham), (2) a sham rats treated with emodin group (TN + E), (3) a TN rats treated with 0.5% sodium carboxymethyl cellulose (CMC) as vehicle group (TN) and (4) a TN rats treated with emodin group (TN + E). The mechanical hyperalgesia threshold of TN rats was tested by Electric Von Frey filaments. The change of the expression of P2X receptors and CGRP in rat's TG was detected with RT-PCR, immunohistochemical staining, and Western blotting. The phosphorylation of p38 and ERK1/2 pathway of TG was detected by Western blotting. After CCI-ION injury, the threshold of mechanical hyperalgesia for the territory of ligated infraorbital nerve in TN group decreased significantly compared with that in sham group. On day 14 after operation of CCI-ION, there was also an evident increase in the expression of P2X receptors and CGRP in the TG of TN group. However after treatment with emodin, the response of mechanical hyperalgesia of TN rats was clearly increased while the enhanced expression of P2X receptor and CGRP in TN rats was significantly decreased. The phosphorylation of p38 and ERK1/2 in TN group was stronger than that in Sham group. But these phosphorylation changes in the TN rats were much weaker after treatment with emodin. In conclusion, P2X receptor may cooperate with CGRP in the pain transmission of TN, and emodin can inhibit the expression and activation of P2X receptor and CGRP in TG to relieve TN.

: The prevalence of chronic pain in children and adolescents is well established. What is not well understood is how over-the-counter (OTC) oral and topical pain treatments are being used by adolescents with chronic pain, their decision making around use of these products, and how they communicate with their health care providers about their use. : The aim of this study was to explore the use, decision-making process, and communication about the use of OTC pain medications with health care professionals among adolescents living with chronic pain and their primary caregiver. : A qualitative descriptive design with semistructured, audiotaped individual interviews was undertaken with adolescents with chronic pain ( = 15, aged 12-18 years, mean age = 16, = 1.79) and their caregivers ( = 16). A convenience sample of patient-caregiver dyads was recruited from a tertiary care pediatric chronic pain clinic in Ontario. : Interview questions focused on four topics: (1) experience with chronic pain and medication; (2) perceptions of medications and concerns with long-term consumption; (3) decision making for use of OTC medications guided mainly by a trusted source or health care professional; and (4) topical OTC medications perceived as harmless. Content analysis within these four topics uncovered two to four subthemes, which are described in detail. : An improved understanding of the prevalence of use, decision-making process around use, and how patients and their families communicate about the use of OTC pain medications with health care providers can help clinicians better personalize treatments and help adolescents with chronic pain to make sound self-care decisions.

Study of acute pancreatitis in chemically-induced rodent models has provided useful data; models of alcoholic chronic pancreatitis have not been available in mice. The aim of the present study was to characterize a mouse model of chronic pancreatitis induced solely with an alcohol and high fat (AHF) diet.