Cooled radiofrequency ablation versus standard medical management for chronic sacroiliac joint pain: a multicenter, randomized comparative effectiveness study.

INTRODUCTION: Low back pain is the leading cause of disability worldwide, with sacroiliac joint pain comprising up to 30% of cases of axial lower back pain. Conservative therapies provide only modest relief. Although placebo-controlled trials show efficacy for sacral lateral branch cooled radiofrequency ablation, there are no comparative effectiveness studies. METHODS: In this randomized, multicenter comparative effectiveness study, 210 patients with clinically suspected sacroiliac joint pain who obtained short-term benefit from diagnostic sacroiliac joint injections and prognostic lateral branch blocks were randomly assigned to receive cooled radiofrequency ablation of the L5 dorsal ramus and S1-S3 lateral branches or standard medical management consisting of pharmacotherapy, injections and integrative therapies. The primary outcome measure was mean reduction in low back pain score on a 0-10 Numeric Rating Scale at 3 months. Secondary outcomes included measures of quality of life and function. RESULTS: 3 months post-treatment, the mean Numeric Rating Scale pain score for the cooled radiofrequency ablation group was 3.8±2.4 (mean reduction 2.5±2.5) compared with 5.9±1.7 (mean reduction 0.4±1.7) in the standard medical management group (p<0.0001). 52.3% of subjects in the cooled radiofrequency ablation group experienced >2 points or 30% pain relief and were deemed responders versus 4.3% of standard medical management patients (p<0.0001). Comparable improvements favoring cooled radiofrequency ablation were noted in Oswestry Disability Index score (mean 29.7±15.2 vs 41.5+13.6; p<0.0001) and quality of life (mean EuroQoL-5 score 0.68±0.22 vs 0.47±0.29; p<0.0001). CONCLUSIONS: In patients with sacroiliac joint pain, cooled radiofrequency ablation provided statistically superior improvements across the spectrum of patient outcomes compared with standard medical management. TRIAL REGISTRATION NUMBER: NCT03601949.

Chronic Pain and Childhood Adversity Experiences Among U.S. Military Personnel.

INTRODUCTION: Chronic pain in a military population is prevalent, is costly, and can limit daily activities and affect soldier readiness. It has been associated with childhood adversity (CA) within the veteran, adult, and pediatric populations. Given the need to maximize soldier resiliency, an examination of the link between CA and chronic pain in an active duty population for a better understanding that informs treatment options is warranted. MATERIALS AND METHODS: The analytic sample comprised 32 men and 8 women drawn from a retrospective review of 203 intake assessments at an interdisciplinary pain management center. We identified a group (CA) of 20 patients who reported a history of pre-adolescent sexual abuse or living in an "abusive" childhood home and compared it with a control group (no-CA) of 20 patients, matched for age, gender, pain history duration, and pain problem. Validated measures were used to assess pain intensity, interference in functioning and well-being, emotional sequelae of pain as reflected in symptoms of depression and anxiety, and pain-related catastrophic thinking. Data were analyzed using descriptive statistics and independent samples t-test analyses. RESULTS: Differences in current, worst, and average pain ratings were non-significant between groups. The CA group reported significantly greater effect of pain on mood (mean: 6.20 versus 4.25, P < .02) and showed a trend toward higher pain interference in functioning (mean: 17.70 versus 15.05, P = .053). The CA patients had significantly more serious depression (mean: 12.65 versus 4.50, P < .001) and anxiety symptoms (mean: 10.60 versus 2.35, P < .001) and significantly higher pain catastrophizing tendency (mean: 30.05 versus 20.50, P < .03). CONCLUSIONS: Overall, the findings suggest that childhood trauma should be considered by providers when treating depression and anxiety in soldiers with chronic pain. Being mindful of trauma-informed care may have implications, perhaps, for cases perceived as treatment resistant.

Factors Associated With Chronic Pain Intensity in U.S. Army Soldiers.

INTRODUCTION: Chronic pain is prevalent among U.S. military personnel and veterans. The effectiveness of evidence-based pain treatments can be boosted with knowledge of factors associated with chronic pain perception. This study examined the factors that influence soldiers' self-rating of their chronic pain intensity. MATERIALS AND METHODS: The study design was a retrospective review of the intake questionnaire from 203 soldiers seen at an Interdisciplinary Pain Management Center. The intake covered various aspects of soldiers' chronic pain experience, including pain intensity, interference in functioning, emotional sequelae, and pain-related catastrophic thinking. Pain intensity and impact were measured using the Defense and Veterans Pain Rating Scale. The mood was measured using the depression (Patient Health Questionnaire [PHQ]-9) and the anxiety (Generalized Anxiety Disorder-7) scales from the PHQ. Pain-related catastrophic thinking was measured using the Pain Catastrophizing Scale (PCS). Pain interference was assessed using a five-item scale that inquired about concentration, life and recreation enjoyment, task performance, and socializing. Data were analyzed using descriptive statistics and linear regression analyses. RESULTS: The mean duration of pain was 34.73 ± 38.66 months. Regression analysis using scores from the PHQ-9, Generalized Anxiety Disorder-7, three PCS subscales (rumination, magnification, and helplessness), and pain interference scale as predictors showed that pain interference and PCS helplessness factors were significant predictors of average pain rating (R2 = 24%, P < .001). CONCLUSIONS: Pain interference in functioning and pain-related thoughts of helplessness accounted for a significant degree of the variance in soldiers' self-rating of their chronic pain. The findings suggest that added attention should be directed at helping patients boost their self-efficacy in using pain-coping methods to improve their functioning and address the perception of helplessness about their pain.

Potential Distribution of Amphibians with Different Habitat Characteristics in Response to Climate Change in South Korea.

Amphibian species are highly vulnerable to climate change with significant species decline and extinction predicted worldwide. However, there are very limited studies on amphibians in South Korea. Here, we assessed the potential impacts of climate change on different habitat groups (wetland amphibians, Group 1; migrating amphibians, Group 2; and forest-dwelling amphibians, Group 3) under future climate change and land cover change in South Korea using a maximum entropy modelling approach. Our study revealed that all amphibians would suffer substantial loss of suitable habitats in the future, except Lithobates catesbeianus, Kaloula borealis, and Karsenia koreana. Similarly, species richness for Groups 2 and 3 will decline by 2030, 2050, and 2080. Currently, amphibian species are widely distributed across the country; however, in future, suitable habitats for amphibians would be concentrated along the Baekdudaegan Mountain Range and the southeastern region. Among the three groups, Group 3 amphibians are predicted to be the most vulnerable to climate change; therefore, immediate conservation action is needed to protect them. We expect this study could provide crucial baseline information required for the government to design climate change mitigation strategies for indigenous amphibians.

Trophic Ecology of Endangered Gold-Spotted Pond Frog in Ecological Wetland Park and Rice Paddy Habitats.

The gold-spotted pond frog (Pelophylax chosenicus) is an endangered amphibian species in South Korea. In order to obtain ecological information regarding the gold-spotted pond frog's habitat environment and biological interactions, we applied stable isotope analysis to quantify the ecological niche space (ENS) of frogs including black-spotted pond frogs (P. nigromaculatus) and bullfrogs (Lithobates catesbeianus) within the food web of two different habitats-an ecological wetland park and a rice paddy. The gold-spotted pond frog population exhibited a broader ENS in the ecological wetland park than in the rice paddy. According to the carbon stable isotope ratios, gold-spotted pond frogs mainly fed on insects, regardless of habitat type. However, the results comparing the range of both carbon and nitrogen stable isotopes showed that gold-spotted pond frogs living in the rice paddy showed limited feeding behavior, while those living in the ecological wetland park fed on various food sources located in more varied trophic positions. Although the ENS of the gold-spotted pond frog was generally less likely to be overlapped by that of other frog species, it was predicted to overlap with a high probability of 87.3% in the ecological wetland park. Nevertheless, gold-spotted pond frogs in the ecological wetland park were not significantly affected by the prey competition with competitive species by feeding on other prey for which other species' preference was low. Since these results show that a habitats' food diversity has an effect on securing the ENS of gold-spotted pond frogs and prey competition, we recommend that the establishment of a food environment that considers the feeding behavior of gold-spotted pond frogs is important for the sustainable preservation of gold-spotted pond frogs and their settlement in alternative habitats.

A comparative study on modeling of the ferromagnetic and paramagnetic states of uranium hydride using a DFT+U method.

Uranium hydride is a promising material for stationary hydrogen storage in fusion reactors. In this work, various material properties of uranium hydride in both ferromagnetic (FM) and paramagnetic (PM) states are calculated to determine the optimal first-principles calculation method. For the treatment of strongly correlated f-electrons, the PBE functional with a Hubbard U parameter of 0.6 eV is selected as the optimal method and provides accurate formation energies and reasonable structural properties of the FM state. Using this method, we test four model spin configurations to approximately simulate the PM state: FM, antiferromagnetic (AFM), special quasi-random structure (SQS) and nonmagnetic (NM) configurations. The FM and AFM configurations provide formation energy and lattice constants comparable to those of the SQS configuration, which is used as the reference PM state. In addition, the experimental results on thermal expansion and the bulk modulus in the PM states are well reproduced with the FM, AFM and SQS configurations. These results demonstrate that PBE+U with FM, AFM and SQS configurations can approximately simulate the PM states, although there are some properties that can only be qualitatively reproduced by DFT calculations, such as the magnetic transition. This study enables the design of multiscale modeling for uranium hydride while maintaining simultaneous efficiency and accuracy.

A new species of salamander of the genus Hynobius (Amphibia, Caudata, Hynobiidae) from South Korea.

We describe a new species of lentic-breeding Hynobius salamander from the Naro Islands, near the village of Bongrae-myeon, Goheung-gun, Jeollanam-do, South Korea, on the basis of results of morphological, ecological and genetic analyses. Hynobius unisacculus sp. nov. is distinguished from its congeners by a combination of the following morphological attributes: (1) comparatively small size (adult SVL up to 61 mm; range 38.3-60.3 mm in males and 37.5-59.9 mm in females); (2) relatively slender short limbs; tips of fore- and hindlimbs adpressed on body never meeting, but separated by a large gap (gap of -3.0 to -1.5 costal folds in males and -3.5 to -1.5 in females); (3) comparatively short tail (TL/SVL ratio in adult males varying from 0.54-0.98, in adult females from 0.55 to 0.89), tail flattened and with a low dorsal fin extending to the posterior one-third of tail length; (4) usually 11 (occasionally 12) costal grooves; (5) in adults, dark brown dorsum with indistinct bronze or dark copper spots, lighter greyish-white or pinkish belly; (6) well developed fifth toe; (7) comparatively shallow vomerine tooth series with 13-23 vomerine teeth; (8) small, pigmented ova, located in one, occasionally two, strings in a small, curved egg sac with folded envelope, lacking distinct mucous stalks or whiptail-like structures on both ends. The molecular differentiation among Korean Hynobius is high; Hynobius unisacculus sp. nov. is genetically highly divergent from the morphologically similar H. leechii, H. yangi and H. quelpaertensis: pairwise distances are 9.7%, 9.1% and 8.0% of sequence divergence at the COI mtDNA gene respectively, and 10.9%, 10.9% and 9.4% of sequence divergence at the cyt b mtDNA gene, respectively. At present, the new species is known from coastal areas and offshore islands in southeastern part of Jeollanam-do in South Korea. We suggest the species should be considered as Vulnerable (Vu2a) in accordance with IUCN's Red List categories. Our study supports the presence of undiagnosed taxonomic diversity among Korean Hynobius.

An in Vivo 3D Computed Tomographic Analysis of Femoral Tunnel Geometry and Aperture Morphology Between Rigid and Flexible Systems in Double-Bundle Anterior Cruciate Ligament Reconstruction Using the Transportal Technique.

PURPOSE: The aim of this study was to compare femoral tunnel length, femoral graft-bending angle, posterior wall breakage, and femoral aperture morphologic characteristics between rigid and flexible systems after double-bundle (DB) anterior cruciate ligament (ACL) reconstruction using the transportal (TP) technique. METHODS: We evaluated 3-dimensional computed tomography (3D-CT) results for 54 patients who underwent DB ACL reconstruction using the TP technique with either a flexible system (n = 27) or a rigid system (n = 27). The femoral tunnel length, femoral graft-bending angle, posterior wall breakage, femoral tunnel aperture height to width (H:W) ratio, aperture axis angle, and femoral tunnel position were assessed using OsiriX Imaging Software and Geomagic Qualify 2012 (Geomagic, Cary, NC). RESULTS: The mean anteromedial (AM) femoral tunnel length of the flexible group was significantly longer than that of the rigid group (P = .009). The mean femoral graft-bending angles in the flexible group were significantly less acute than those in the rigid group (AM, P < .001; posterolateral [PL], P = .003]. Posterior wall breakage was observed in both groups (P = 1.00). The mean H:W ratios in the rigid group were significantly larger (more elliptical) than those of the flexible group (AM, P < .001; PL, P = .006). The mean aperture axis angle of the PL femoral tunnel in the rigid group was more parallel to the femoral shaft axis than that in the flexible group (P < .001). There were no significant differences in femoral tunnel position between the 2 groups. CONCLUSIONS: The AM femoral tunnel length and the AM/PL femoral graft-bending angle of the flexible system were significantly longer and less acute than those of the rigid system. However, the aperture morphologic characteristics of the AM/PL femoral tunnel and the aperture axis angle of the PL femoral tunnel in the rigid system were significantly more elliptical and closer to parallel to the femoral shaft axis than those of the flexible system. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Mitochondrial genome sequence of Sibynophis chinensis (Squamata, Colubridae).

The complete mitochondrial (mt) genome of the Chinese many-toothed snake, Sibynophis chinensis, was sequenced and found to be 17,163 bp in length. The arrangement of 13 protein-coding genes, tRNAs and rRNAs was identical to that of other common snake mt genomes. The mt protein-coding genes of S. chinensis utilized ATA, ATG, ATA and GTG as initiation codons and AGA, AGG, TAA, TAG and T as termination codons. Among three tRNA clusters (LQM, WANCY and HSL), LQM was found instead of IQM, which is common in other vertebrates. We also identified two control regions that contained several conserved elements known as conserved sequence blocks and termination-associated sequences related to mt replication and transcription.

Computed tomography analysis of the femoral tunnel position and aperture shape of transportal and outside-in ACL reconstruction: do different anatomic reconstruction techniques create similar femoral tunnels?

BACKGROUND: The desire to perform independent femoral drilling in anterior cruciate ligament (ACL) reconstruction has prompted interest in both the transportal (TP) and outside-in (OI) techniques. However, there have been no in vivo studies on the differences in femoral aperture shape between the 2 techniques. PURPOSE: To evaluate the femoral tunnel aperture shape and femoral tunnel position between ACL reconstruction using the TP and OI techniques. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A total of 80 patients were randomized to undergo double-bundle ACL reconstruction using either the TP (n = 40) or OI (n = 40) technique. The femoral tunnel aperture shape (height/width ratio), aperture axis angle (angle between the aperture axis and femoral shaft axis), and femoral tunnel position were assessed by computed tomography. RESULTS: The mean height/width ratio of the anteromedial (AM) femoral tunnels in the TP group (1.35 ± 0.16) was significantly more ellipsoidal than that in the OI group (1.22 ± 0.16) (P = .008). There was no difference between the 2 groups in the posterolateral (PL) tunnels (TP, 1.32 ± 0.23; OI, 1.35 ± 0.29; P = .99). The mean aperture axis angle of the PL femoral tunnels in the OI group was significantly more perpendicular to the femoral shaft axis and had a more variable range than that in the TP group (P = .007). The mean PL femoral tunnel position in the OI group was significantly shallower and a little higher than that in the TP group (P = .006). CONCLUSION: The TP technique revealed a more ellipsoidal AM femoral tunnel aperture than the OI technique. The mean PL femoral tunnel position in the OI group was significantly shallower than that in the TP group, with a more variable and more perpendicular aperture axis angle to the femoral shaft axis. CLINICAL RELEVANCE: The TP technique might be more advantageous than the OI technique in terms of graft coverage, with a more ellipsoidal AM femoral tunnel and more horizontal and consistent PL aperture axis angle. In addition, it may be useful to consider the shallower PL femoral tunnel positions created with the OI technique.

Migration route estimation of the Jeju striped field mouse Apodemus agrarius chejuensis (Rodentia, Muridae).

The taxonomic relationship between two Korean field mice species, Apodemus agrarius coreae and A. a. chejuensis, as well as their possible historic migration routes, was examined by molecular genetic analysis of the complete mitochondrial cytochrome b gene of 73 mice collected from the Korean Peninsula and Jeju Island. Our findings suggest that A. a. coreae and A. a. chejuensis populations expanded and dispersed rapidly. Bayesian and network analysis showed that A. a. chejuensis is a clearly distinct population, and that A. a. chejuensis originated from the ancestral lineage of A. a. coreae. Based on our data, we hypothesize that the A. a. coreae population originated from eastern China or elsewhere. After the last glacial epoch, the lineage isolated from A. a. coreae had adapted to the new environment of Jeju Island, and with the reproductive isolation caused by the geographic barrier, this lineage eventually became a distinct population.

Mitochondrial genome sequences of the striped field mice Apodemus agrarius coreae and Apodemus agrarius chejuensis.

We determined the complete mitochondrial (mt) genome sequences of the striped field mice Apodemus agrarius coreae and Apodemus agrarius chejuensis. The mt genomes of A. a. coreae and A. a. chejuensis are 16,260 and 16,261 base pairs in length, respectively. The general features of the 13 protein-coding genes of the two species are similar to those of other rodents. The TAG termination codon for NADH dehydrogenase subunit (ND) 3 is unique to Apodemus in the Muroidea. The L-strand replication origin has the potential to form a stable stem-loop structure. Within the control region, a termination-associated sequence and several conserved sequence blocks were observed. The diversity of the 13 protein-coding genes, 2 rRNAs, and 1 control region between the two species ranged between 0.005 (ATP8) and 0.027 (ND4L).

The mitochondrial genome of Apodemus peninsulae (Rodentia, Muridae).

The complete mitochondrial (mt) genome of the Korean field mouse Apodemus peninsulae was sequenced and found to be 16,266 bp in length. The mt protein-coding genes of A. peninsulae had ATG, GTG, ATC, and ATA as initiation codons and TAA, TAG, TA, and T as termination codons. Two forms each of trnL and trnS and the three tRNA clusters, IQM, WANCY, and HSL were identified, as in the typical Rodentia mt genome. Among tRNAs, abnormal cloverleaf structure of trnS((AGY)) was identified in DHU arm. The l-strand replication origin has the potential to form a stable stem-loop structure and control region has several conserved sequence elements.