Multimodal phenotyping and correlates of pain following hematopoietic cell transplant in children with sickle cell disease.

INTRODUCTION: There is limited understanding of pain, patient-reported outcomes (PROs) of health-related quality of life (HRQoL), psychological factors, and experimental pain sensitivity before and following hematopoietic cell transplant (HCT) in children with sickle cell disease (SCD). METHODS: Individuals aged 8 years and older, English speaking, and scheduled for a HCT were invited to participate in an observational study where they completed assessments of pain, PROs, psychological factors, and qualitative interviews before and around 3 months, 6 months, 1 year, and 2 years post-HCT. An optional substudy of experimental pain sensitivity before and around 6 month, 1 year, and 2 years post-HCT was also offered. RESULTS: Data from eight participants (median age 13.5 years, 25% female) with sickle cell anemia (SCA) or similarly severe genotype, and successful donor-derived erythropoiesis post-HCT are reported. We found that collection of pain, PROs, psychological factors, and qualitative data were feasible in the context of HCT. We found moderate to large differences in pain and some PROs between baseline to 1 year and baseline to 2 year post-HCT based on effect sizes, but only some differences were statistically significant. We found moderate to large differences in pressure pain threshold and moderate differences in cold pain threshold between baseline to 1 year and baseline to 2 year post-HCT based on effect sizes, but these differences were not statistically significant. Qualitative data indicated an improvement in pain and HRQoL post-HCT. CONCLUSION: This study provides a framework for the conduct of multimodal pain assessments before and after HCT, which is feasible but faced with unique barriers.

A pilot study of the acceptability, feasibility and safety of yoga for chronic pain in sickle cell disease.

OBJECTIVES: To determine the acceptability, feasibility and safety of yoga for chronic pain in sickle cell disease. DESIGN AND SETTING: In Part A of this two-part study, adolescents with SCD and chronic pain (Group 1) and their parent (Group 2) completed a survey designed to capture pain characteristics, attitudes and practices related to yoga, and potential acceptability of a yoga program. In Part B, the study assessed the feasibility and safety of an instructor-led group yoga program. The study was registered on clinicaltrials.gov (NCT03694548). INTERVENTION: Eight instructor-led group yoga sessions. MAIN OUTCOME MEASURES: Feasibility and safety outcomes were chosen a priori, as follows: 1) Proportion of adolescent patients with SCD and chronic pain approached that consent to participate in Part A, 2) Proportion of adolescent participants enrolled in Part A that consent to participate in Part B, 3) Proportion of participants enrolled in Part B that attend at least 6 of 8 yoga sessions, 4) Proportion of participants enrolled in Part B with an ED visit or a hospitalization for pain within 24 h of completion of each yoga session, 5) Proportion of participants in Part B who complete all study assessments before, and at the end of the yoga program, 6) Adherence to submission of pain diary. RESULTS: The median age of 15 patient participants in Part A was 16 (IQR 14-17), and 14 parents was 43.5 (IQR 42-51). Most participants were female. Most participant responses indicated a positive opinion of yoga. Nine adolescents (60 %) from Part A participated in Part B of the study. The median age of 9 participants in Part B was 17 (IQR 15-18), and 5 of the 9 participants were female (53.3 %). Only one participant was able to attend 3 of the 8 yoga sessions offered, and did not experience any ED visits or hospitalizations following the yoga sessions. None of the other feasibility endpoints were met in this study. CONCLUSIONS: Patients with SCD and chronic pain overall have a positive opinion of yoga, but there are challenges with recruitment and retention of participants in a clinical trial of yoga, and barriers to feasibility of an in-person group yoga intervention.

Antibacterial hop extracts encapsulated in nanochitosan matrices.

Hops and the components extracted from them are well known antibacterial agents used in beers and as food preservatives, in formulations for topical applications on their own or together with other antimicrobial agents, in hormone replacement therapy, as antioxidants, tumor development antagonists, and angiogenesis inhibitors. Their shortcomings: very low bioavailability, bitter taste, and susceptibility to oxidative decomposition have limited their applications. We propose nanosized chitosan, an inexpensive, readily available biopolymer with a broad spectrum of antibacterial activity, as carrier for lupulone (L) and xanthohumol (X), two components of hops. Chitosan nanoparticles (CNP) and chitosan-based nanocomposites encapsulating lupulone (CNL) and xanthohumol (CNX) were prepared by ionotropic gelation using sodium tripolyphosphate (TPP) as crosslinker. Different preparative ratios and conditions were investigated and the nanoparticles obtained were characterized by FTIR, colloidal titration, size, zeta potential, and antimicrobial activity. The kinetics of the release of L/X from composites was studied in vitro. All the nanoparticles were active against several Gram-positive, Gram-negative, and Candida strains. Synergistic interactions were observed in all cases, although hops are known mainly for their activity against Gram-positive bacteria. All nanoparticles showed good stability over several months.