Communicating Endometriosis Pain in France and Australia: An Interview Study.

Endometriosis is characterized by persistent, fluctuating pain associated with menstruation, a biological function which is socially invisible. The degree and quality of pain cannot easily be measured, observed, or documented. Difficulties in communicating pain pose particular challenges when seeking diagnosis and support from health professionals. In this paper we explore the experiences and characterization of pain by thirteen Australian and thirteen French women with endometriosis. Data were collected through semi-structured interviews using a life-history approach to illness symptoms, diagnosis and treatment. We explore the experiences of women with endometriosis in two phases: from onset of symptoms to seeking advice from a clinician, and from first consulting a clinician to receiving a diagnosis. On average, initial pain symptoms were identified 2.1 years before consulting a health practitioner, after which women reported pain symptoms 8.5 years prior to diagnosis; that is, the time between consulting a clinician and receiving a diagnosis was almost four times the period between experiencing symptoms and consulting a doctor. Pain was often "made real" to doctors by findings consistent with endometriosis on ultrasound and MRI, mostly used in France, or laparoscopy, the predominant diagnostic tool in Australia. No woman described her practitioner using standardized pain assessment tools. Thus, the validation of pain relies largely on disease visibility and the clinician-classified degree of severity rather than self-reported grades of pain or impact on activities of daily living. The invisible and enigmatic pain of this chronic women's disease remains difficult to communicate to doctors, and the recognition of severe pain is often key to timely diagnostic procedures. Clinicians need to be more proactive about severe pain related to menstruation, taking into consideration women's individual circumstances, and maintain a high index of suspicion of underlying endometriosis as a condition characterized primarily by pain.

Postural sway correlates with cognition and quality of life in Parkinson's disease.

BACKGROUND: The severity of Parkinson's disease (PD) is difficult to assess objectively owing to the lack of a robust biological marker of underlying disease status, with consequent implications for diagnosis, treatment and prognosis. The current standard tool is the Unified Parkinson's Disease Rating Scale (MDS-UPDRS), but this is hampered by variability between observers and within subjects. Postural sway has been shown to correlate with complex brain functioning in other conditions. This study aimed to investigate the relationship between postural sway, MDS-UPDRS and other non-motor measures of disease severity in patients with PD. METHOD: 25 patients with PD and 18 age-matched controls participated in the study. All participants underwent assessment of postural sway using a force plate, with eyes open and closed. In addition, participants underwent tests of cognition and quality of life: Montreal Cognitive Assessment (MoCA), Neuropsychiatry Unit Cognitive Assessment (NUCOG) and, for the patients, the Parkinson's Disease Questionnaire (PDQ-39-1), and assessment of clinical status using the motor component of the MDS-UPDRS. RESULTS: Patients swayed significantly more than controls. This was most obvious in the eyes-closed condition. Sway path length showed strong correlations with PDQ-39-1, MoCA and the verbal fluency component of the NUCOG, and, to a lesser degree, with the UPDRS-III in patients with PD. CONCLUSION: These results suggest that motor and non-motor symptoms of PD are associated in patients, and, in particular, that postural sway shows potential as a possible measure of underlying disease status in PD, either alone or in combination with other measures.

Ultraviolet radiation, vitamin D and multiple sclerosis.

There is compelling epidemiological evidence that the risk of developing multiple sclerosis is increased in association with low levels of sun exposure, possibly because this is associated with low vitamin D status. Recent work highlights both vitamin D and non-vitamin D effects on cellular immunity that suggests that higher levels of sun exposure and/or vitamin D status are beneficial for both MS risk and in ameliorating disease progression. Here we review this recent evidence, focusing on regulatory cells, dendritic cells, and chemokines and cytokines released from the skin following exposure to ultraviolet radiation.

Action potential generation requires a high sodium channel density in the axon initial segment.

The axon initial segment (AIS) is a specialized region in neurons where action potentials are initiated. It is commonly assumed that this process requires a high density of voltage-gated sodium (Na(+)) channels. Paradoxically, the results of patch-clamp studies suggest that the Na(+) channel density at the AIS is similar to that at the soma and proximal dendrites. Here we provide data obtained by antibody staining, whole-cell voltage-clamp and Na(+) imaging, together with modeling, which indicate that the Na(+) channel density at the AIS of cortical pyramidal neurons is approximately 50 times that in the proximal dendrites. Anchoring of Na(+) channels to the cytoskeleton can explain this discrepancy, as disruption of the actin cytoskeleton increased the Na(+) current measured in patches from the AIS. Computational models required a high Na(+) channel density (approximately 2,500 pS microm(-2)) at the AIS to account for observations on action potential generation and backpropagation. In conclusion, action potential generation requires a high Na(+) channel density at the AIS, which is maintained by tight anchoring to the actin cytoskeleton.