Psychosocial and psychophysical assessment in paediatric patients and young adults with chronic back pain: A cluster analysis.

BACKGROUND: Identifying subgroups with different clinical profiles may inform tailored management and improve outcomes. The objective of this study was to identify psychosocial and psychophysical profiles of children and adolescents with chronic back pain. METHODS: One hundred and ninety-eight patients with chronic back pain were recruited for the study. Pain assessment was mainly conducted in the form of an interview and with the use of validated pain-related questionnaires assessing their psychosocial factors and disability. All patients underwent mechanical and thermal quantitative sensory tests assessing detection and pain thresholds, and conditioned pain modulation efficacy. RESULTS: Hierarchal clustering partitioned our patients into three clusters accounting for 34.73% of the total variation of the data. The adaptive cluster represented 45.5% of the patients and was characterized to display high thermal and pressure pain thresholds. The high somatic symptoms cluster, representing 19.2% of patients, was characterized to use more sensory, affective, evaluative and temporal descriptors of pain, more likely to report their pain as neuropathic of nature, report a more functional disability, report symptoms of anxiety and depression and report poor sleep quality. The pain-sensitive cluster, representing 35.4% of the cohort, displayed deep tissue sensitivity and thermal hyperalgesia. CONCLUSIONS: This study identified clinical profiles of children and adolescents experiencing chronic back pain based on specific psychophysical and psychosocial characteristics highlighting that chronic pain treatment should address underlying nociceptive and non-nociceptive mechanisms. SIGNIFICANCE: To our current knowledge, this study is the first to conduct cluster analysis with youth experiencing chronic back pain and displays clinical profiles based on specific physical and psychosocial characteristics. This study highlights that in a clinical context, chronic pain assessment should include multiple elements contributing to pain which can be assessed in a clinical context and addressed when pathoanatomical symptoms are unidentifiable.

Role of tumor-derived transforming growth factor-beta1 (TGF-beta1) in site-dependent tumorigenicity of murine ascitic lymphosarcoma.

An ascitic lymphosarcoma (LS-A) of Swiss mice that regressed spontaneously on subcutaneous (s.c.) transplantation was investigated for the mechanism of its progressive growth and host mortality on intraperitoneal (i.p.) transplantation. In vitro studies indicated significant inhibition of LS-A proliferation seeded at higher cell density (>10(4)/ml). Culture supernatants of LS-A caused bi-modal growth effects, the early supernatants (24 h) caused stimulation and the late (72 h) supernatants inhibited LS-A proliferation. The 72-h supernatants also suppressed T and B cell response to mitogens in a dose-dependent manner. Pan anti-transforming growth factor-beta antibody abrogated the inhibitory effects of supernatants. The supernatants contained both latent as well as bio-active form of transforming growth factor-beta1 (TGF-beta1) as determined by ELISA. Mice bearing i.p. ascites tumor had elevated serum TGF-beta1, hemoglobulinemia, splenic lymphopenia, impaired response of the T cells to mitogen and reduced expression of transferrin receptor (CD71) on the bone marrow cells. However, mice which rejected s.c. transplants, did not show significant changes in these parameters. Our studies indicated profound influence of site of tumor growth on tumor progression and host immune system mediated by tumor-derived TGF-beta1. It is possible that human tumors which secrete TGF-beta1 may exhibit similar patho-physiological effects in the host depending on the anatomical site of the tumor.

Modification of immune response by low dose ionizing radiation: role of apoptosis.

Acute as well as fractionated whole body exposures to low doses (< 50 cGy) of ionizing radiation (LDR) have been reported to alter several immunological parameters in experimental animals. It is, however, not clear whether the augmentation of immune response by LDR will be observed for all responses and across genetic barriers. Since several proteins including p53 are synthesized following radiation exposure, the role of p53 and consequently that of activation induced apoptosis in the immunomodulation by LDR also remained to be evaluated. Experiments were, therefore, carried out in two different strains of inbred mice viz. C57BL/6 and BALB/c, exposed to fractionated LDR (4 cGy/day, 5 days/week, total dose 20 cGy) and subsequently stimulated with the polyclonal mitogen Con A or immunized with Mycobacterium vaccae or dinitrofluorobenzene (DNFB) for delayed type hypersensitivity (DTH) response. The proliferation of spleen cells in response to con A as measured by [3H]thymidine incorporation was significantly higher in 20 cGy-irradiated C57BL/6 mice as compared with that in the Con A-stimulated cells from sham-irradiated controls. The same response was suppressed by LDR in BALB/c mice. On the other hand, DTH to M. vaccae as well as DNFB was suppressed in C57BL/6 mice while DTH to M. vaccae was augmented in BALB/c mice and that to DNFB was not significantly affected following same dose. The augmentation of response to con A in C57BL/6 mice was prominent in CD4- (CD8+) T cells and was marked by the decrease in the proportion of cells expressing p53 as estimated by flow cytometry. Reduction in expression of p53 was accompanied by reduced apoptosis, as measured by TUNEL assay, in the Con A-stimulated spleen cells of irradiated C57BL/6 mice when compared with that in the sham-treated controls. The spleen cells of BALB/c mice showed exactly opposite profiles in this respect. Thus alteration in the immune response following LDR depends on antigen, type of response as well as the strain of mice used. Furthermore, the alterations in the expression of pro-apoptosis gene p53 and activation induced apoptosis in the effector or regulatory cells seem to contribute to the end result.

Cardiopulmonary arrest in general wards: a retrospective study of referral patterns to an intensive care facility and their influence on outcome.

OBJECTIVE: To analyse the effect on outcome of referral to specialist facilities after cardiopulmonary arrest in a general ward. METHODS: A retrospective analysis of resuscitation records of 743 patients in whom cardiopulmonary resuscitation was performed in a general ward between 1988 and 1992. After successful initial cardiopulmonary resuscitation, patients were identified as transferred to coronary care unit (CCU) or intensive care unit (ITU), or as staying in a general ward. MAIN OUTCOME MEASURE: Survival to discharge home. RESULTS: There were 322 initial survivors, of whom 148 (20% of the overall total) survived to be discharged from hospital; 63% of those transferred to CCU and 48% of those transferred to ITU survived to discharge, compared with 28% of those who stayed on the ward (P < 0.001). Of those aged less than 65 years, 75% survived to discharge after transfer to CCU and 54% after transfer to ITU, compared with 44% of those who stayed on the ward (P = 0.023); the respective figures for those over 65 years were: CCU 25%, ITU 34%, ward 25% (P = 0.014). Only half of those aged more than 65 years were transferred to a specialist facility, compared with 90% of those aged less than 65. CONCLUSIONS: Transfer to a specialist care facility after resuscitation from cardiopulmonary arrest has an influence on outcome. Age as an independent factor is not an appropriate criterion to use in deciding on transfer. The decision to arrange transfer must always be taken by the most experienced person available, and in line with peer reviewed guidelines.

Immunochemical localization and characterization of proteins from mouse cauda epididymis using human sperm specific monoclonal antibody.

Monoclonal antibodies (mAbs) to sperm specific antigens were generated by fusion of mouse myeloma cells (SP2/0) with splenocytes of female BALB/c mice hyperimmunized with washed human spermatozoa. The resultant hybridomas producing antisperm antibodies were first screened by ELISA. Out of these, one of the mAbs (D2G4) which recognized target antigens restricted to the acrosomal cap was chosen for these studies. The mAb D2G4 was found to be an agglutinating antibody and was also found to cross-react with mouse epididymal spermatozoa in ELISA and indirect immunofluorescence. The origin of antigens reacting with monoclonal antibody D2G4 was investigated. When frozen sections of murine testis and various regions of epididymis were reacted with mAb D2G4, only the cauda epididymal region was stained. Western blot of proteins from the epididymal spermatozoa and fluid indicated the presence of two bands of mol. wt 45 and 26 kd. These bands were identical under reducing and non-reducing conditions. These observations suggest that the two proteins are structurally similar or at least have a common epitope. These data indicate that the proteins recognized by D2G4 are acquired by spermatozoa during their passage and storage in the cauda epididymis.