Rejected

An important challenge for colloid scientists is to design injectable dispersions that provide structural support for damaged soft tissue and enable regeneration of tissue over the longer term. In this article we highlight a new area of research that aims to produce pH-responsive microgel dispersions that restore the mechanical properties of damaged, load-bearing, soft tissue. Chronic back pain due to degeneration of the intervertebral disc (IVD) is a major health problem and is the primary potential application for the work discussed. pH-Responsive microgel dispersions contain cross-linked polymer particles that swell when the pH approaches the pKa of the incorporated ionic co-monomer. The work considered here involves microgel particles containing MAA (methacrylic acid). The particles show pronounced pH-triggered swelling. The concentrated microgel dispersions change from a fluid to a gel at pH values greater than ca. 6.2, which is within the physiological pH range. The rheological properties are pH-dependent and can be adjusted using particle composition or concentration. Degenerated IVDs containing injected, gelled, microgel dispersions show improved mechanical properties. The disc height under biomechanically meaningful loads can be restored to values observed in non-degenerated IVDs. We also discuss the steps required to provide a minimally invasive injectable microgel system for restoring both the IVD mechanical properties and regenerating tissue in vivo. The approach discussed should also be suitable for other soft tissue types in the body.

The radiographers role in trauma has been traditionally limited to image acquisition, but has evolved to include responsibility for image interpretation. The contribution to ongoing patient management has been limited, despite pressure on A&E systems to decrease any potential delays.

This study examined delivery pain as a possible risk factor for the development of mother-infant interaction. Eighty-one mothers completed the Pain Catastrophizing Scale, the State-Trait Anxiety Inventory, and the Edinburgh Postnatal Depression Scale. A retrospective evaluation of labor pain was performed using the Visual Analog Scale at 2 days postpartum. Six weeks after birth the mothers were visited at home, completed measures of anxiety and depression, and were observed during a free play session with the infant. The mother's tendency to catastrophize pain predicted lower levels of mother-infant reciprocity at 6 weeks, controlling for maternal age, education, parity, epidural analgesia, pain perception, anxiety, and depression. Trait anxiety was related to lower maternal sensitivity. The mother's tendency to catastrophize pain was discussed in relation to the personality trait of exaggerated emotional perception of pain and its potential interference with the formation of the mother-infant relationship.

Violence towards an intimate partner, substance misuse and other mental health disorders are problems that tend to cluster together and result in multiple burdens for afflicted individuals (Desjarlais , 1995; Wyshak & Modest, 1996; Wyshak, 2000). They are prevalent not only in high-risk groups but also among members of the general public seeking primary healthcare (Bauer , 2000; World Health Organization, 2001), where their afflictions often go undiagnosed and untreated (Edlund , 2004; Kramer , 2004). Furthermore, violence towards an intimate partner, substance misuse and other mental health disorders involve common symptom pathways, such as psychiatric distress, headache, abdominal pain, gastrointestinal problems and multiple somatic complaints (Berwick , 1991), which suggests that the use of an integrated set of screening instruments may lead to early detection and treatment for patients who are suffering from one or more of these problems.

In this study, semen was obtained by rectal probe electrostimulation (RPE) from the Sulawesi crested black macaque (Macaca nigra). Three experimental series were conducted. First, semen was collected from four animals anesthetized with either tiletamine-zolazepam (Telazol®) or ket-amine-HCl (Vetalar®) (five collections from each animal with each drug). Because of greater muscle relaxation and analgesia, we found tiletaminezolazepam to be an attractive alternative to ketamine-HCl as an anesthetic agent for RPE in M. nigra. Second, semen was collected from another four animals at stimulation frequencies of either 30 Hz or 60 Hz (five collections from each animal at each frequency). There were no significant differences in sperm number, in percentage of sperm with progressive motility, in the current required for sample recovery between tiletamine-zolazepam or ketamine-HCl anesthesia, or between a 30 Hz or 60 Hz stimulation frequency. Third, to check for retrograde sperm loss, the bladders of four animals were emptied, flushed with sterile saline, and then infused with TALP-Hepes medium. After RPE, sperm numbers in the bladder were compared with those in the ejaculate. Although sperm were recovered from the bladder [1.6 (± 0.9) × 10] (mean ± SEM), the numbers were significantly less (P < 0.05) than those in the ejaculate [49 (± 18) × 10]. The percentage of sperm with normal morphology in these samples was high (96.8 ± 1.0%). The average sperm number in the 84 samples collected for this study was 33.8 (± 4.1) × 10. In preliminary experiments, we found that M. nigra sperm will fertilize rhesus monkey oocytes (Macaca mulatta) in vitro. © 1992 Wiley-Liss, Inc.

To identify an anesthetic regimen that produces more complete relaxation and analgesia than ketamine hydrochloride (Ketaset®) alone, a combination of ketamine (15 mg/kg body weight) and the hypnotic xylazine (Rompun®, 0.33 mg/kg) was evaluated. Since the desired experimental application required that the anesthetic not interfere with normal hormonal events during the menstrual cycle, this combination administered on day 6 of the cycle was tested to determine whether hormonal surges, incidence of ovulation, or cycle length would be altered relative to the use of ketamine alone. In five of six animals, ketamine plus xylazine had no effect on the occurrence of timely surges of estrogen, luteinizing hormone (LH), or follicle-stimulating hormone (FSH), or on ovulation as determined by the presence of a corpus luteum at laparoscopy and normal serum concentrations of progesterone. There were no significant differences between the cycle during treatment and previous cycles in the same animal for length of the menstrual cycle (26.0 ± 2.3 [5] days; X̄ ± S.D. [n] or luteal phase (13.4 ± 2.4 [5] days). Likewise, these values did not differ from those of ten control monkeys treated with ketumine only on day 5 or 6 of the cycle (incidence of ovulation, 10/10; cycle length, 27.9 ± 1.8 [10]; luteal phase length, 15.1 ± 1.4 [10], P > 0.05). Patterns of circulating progesterone were not altered by the addition of xylazine anesthesia. These findings indicate that xylazine, given in the midfollicular phase, did not alter ovulatory events or menstrual cycle characteristics in rhesus monkeys. Ketamine plus xylazine apparently provides anesthesia appropriate for laparoscopy.

Invasive surgical procedures are often used to study the reproductive and adrenocortical endocrine systems in primates. Anesthetic agents must, therefore, be used that have the least confounding effects on these systems. The present study was designed to characterize various adrenocortical endocrine responses of female baboons (Papio anubis), each treated for 120 minutes with an infusion of ketamine HCl (6 mg/min) in 5% dextrose in water (0.40 ml/min), a combination of ketamine and acetylpromazine (0.6 mg acetylpromazine and 6 mg ketamine HCl/min) in 5% dextrose in water, or inhalation of vaporized halothane (1.0% halothane, NO 25%, 1 liter/min; O 75%, 3 liters/min). Blood samples were collected throughout the treatment period, and serum was assayed for prolactin (PRL), dehydroepiandrosterone (DHA), dehydroepiandrosterone sulfate (DHAS), and cortisol (F). No significant elevations in DHA, F, or PRL concentrations were found following infusion of ketamine alone. Only serum DHAS concentrations were significantly altered after long-term exposure to ketamine. Acetylpromazine increased PRL concentrations tenfold to levels significantly greater than those in ketamine- and halothane-treated animals but had no effect on serum DHA, DHAS, or F. Treatment with halothane had no effect on serum PRL, DHA, or DHAS but did suppress F (>40%) concentrations over time. These data indicate that ketamine is best suited for the collection of biological samples when deep analgesia is not required but that halothane is preferable in the latter situation.

The standard of care calls for the assessment of patients with chronic pain prior to the initiation of opioids, with one part of this assessment including assessment of the risk of misuse of medications. However, traditional opioid risk assessment tools focus almost entirely on individual factors and on the risk of misuse and addiction to opioids. Diversion of opioid medications has been found to be not uncommon, but to date, there have been no assessment tools specifically designed to assess the risk of diversion. In this study, we developed a measure designed specifically to assess the risk of an opioid medication ending up in the hands of someone other than the chronic pain patient to whom they were prescribed. A 15-item measure, the Diversion Risk Scale, was created and administered to 85 patients at a chronic pain practice. Results found that the measure had acceptable predictive validity. It was moderately correlated with traditional opioid risk assessment tools and showed improved ability to predict specific indicators of diversion. Diversion has been an understudied phenomenon, and the clinical value of an assessment tool that can help predict diversion in the chronic pain population is discussed.

Administration of glyceryl trinitrate (GTN), a donor of nitric oxide, can induce migraine-like attacks in subjects with migraine. Provocation with GTN typically follows a biphasic pattern; it induces immediate headache in subjects with migraine, as well as in healthy controls, whereafter only subjects with migraine may develop a migraine-like headache several hours later. Interestingly, intravenous infusion with prostaglandin-E (PGE) can also provoke a migraine-like headache, but seems to have a more rapid onset compared to GTN. The aim of the study was to shed light on the mechanistic aspect PGE has in migraine attack development. Therefore, PGE plasma levels were measured towards the (pre)ictal state of an attack, which we provoked with GTN. Blood samples from women with migraine (n = 37) and age-matched female controls (n = 25) were obtained before and ∼ 140 min and ∼ 320 min after GTN infusion. PGE levels were measured using liquid chromatography tandem mass spectrometry (LC-MS/MS) analysis. Data was analyzed using a generalized linear mixed-effect model. Immediate headache after GTN infusion occurred in 85 % of migraine participants and in 75 % of controls. A delayed onset migraine-like attack was observed in 82 % of migraine subjects and in none of the controls. PGE levels were not different between the interictal and preictal state ( = 0.527) nor between interictal and ictal state (defined as having migraine-like headache) ( = 0.141). Hence, no evidence was found that a rise in PGE is an essential step in the initiation of GTN-induced migraine-like attacks.

Ocular pain is a common complaint, and anything that stimulates the sensory nerve terminals innervating the eye, the peripheral axons of neurons located in the trigeminal ganglion, can cause it. An undetected ocular foreign body sometimes masquerades as a common condition such as dry eye or other frequencies, which can misguide both the doctor and the patient into an endless cycle of ineffective therapies and incomplete diagnoses. In recent years, as the concept of neuropathic pain has become more widely recognized, cases of idiopathic ocular pain in which the actual cause of the discomfort is a foreign body seem to be increasingly misdiagnosed as neuropathy. This report reviews cases in which hidden foreign bodies were responsible for unresolved, long-lasting chronic ocular pain. All records referencing the phrase "foreign body removal" were extracted from the outpatient clinic notes recorded by the author (H.T.) between 2016 and 2018 at Ashikaga Red Cross Hospital using the search engine of the computerized record system. There were 3 cases that were very difficult to diagnose: (1) a very minute iron shard in a 72-year-old female cataract surgery patient, (2) a deeply hidden eyelash in a 60-year-old female with varicella-zoster virus-related keratoconjunctivitis, and (3) an extremely small grain of sand in an 83-year-old female diagnosed with dry eye. In all cases, the foreign body was detected in an area of the upper palpebral conjunctiva without typical pathognomonic signs. Removing the foreign bodies led to immediate and dramatic relief of long-lasting, previously unresolved chronic ocular pain.