Pain, disability and health-related quality of life in osteoarthritis-joint matters: an observational, multi-specialty trans-national follow-up study.

The authors aimed to test potential relations between osteoarthritis (OA) features, disability and health-related quality of life (HR-QoL) at different body locations. Outpatients consulting for pain associated to self-reported OA at varied healthcare settings were evaluated in a 3-month observational non-controlled follow-up study. Socio-demographic/anthropometric and medical data were collected at three time points. Lequesne's indices, quick-disabilities of arm, shoulder and hand (DASH) and Oswestry questionnaires provided measures of physical function and disability. HR-QoL measures were obtained with EuroQol-5 Dimensions. Multivariate analyses were used to evaluate the differences of pain severity across body regions and the correlates of disability and HR-QoL. Six thousand patients were evaluated. Pain lasted 2 years or more in 3995 patients. The mean pain severity at baseline was moderate (6.4 points). On average, patients had pain in 1.9 joints/areas. The pain was more severe when OA involved the spine or all body regions. Pain severity explained much of the variance in disability and HR-QoL; this association was less relevant in patients with OA in the upper limbs. There were considerable improvements at follow up. Pain severity improved as did disability, which showed particularly strong associations with HR-QoL improvements. Pain severity is associated with functional limitations, disability and poor HR-QoL in patients with self-reported OA. Functional limitations might have particular relevance when OA affects the upper limbs. Improvements are feasible in many patients who consult because of their pain.

Energy-conserving coarse-graining of complex molecules.

Coarse-graining (CG) of complex molecules is a method to reach time scales that would be impossible to access through brute force molecular simulations. In this paper, we formulate a coarse-grained model for complex molecules using first principles caculations that ensures energy conservation. Each molecule is described in a coarse way by a thermal blob characterized by the position and momentum of the center of mass of the molecule, together with its internal energy as an additional degree of freedom. This level of description gives rise to an entropy-based framework instead of the usual one based on the configurational free energy (i.e. potential of mean force). The resulting dynamic equations, which account for an appropriate description of heat transfer at the coarse-grained level, have the structure of the dissipative particle dynamics with energy conservation (DPDE) model but with a clear microscopic underpinning. Under suitable approximations, we provide explicit microscopic expressions for each component (entropy, mean force, friction and conductivity coefficients) appearing in the coarse-grained model. These quantities can be computed directly using MD simulations. The proposed non-isothermal coarse-grained model is thermodynamically consistent and opens up a first principles CG strategy for the study of energy transport issues that are not accessible using current isothermal models.

A propósito de un caso; paciente joven con tumor desmoide de mama diagnosticado tras tumorectomía / Desmoid breast tumor diagnosed after lumpectomy in a young patient a case report

Presentamos el caso de una paciente de 16 años, sin antecedentes ginecológicos de interés, con previo diagnóstico de tumor filoides en línea intercuadrántica de mama derecha. Tras ser tratada con tumorectomía, y tras el estudio anatomopatológico de la pieza, resultó estar afecta de tumor desmoide en mama. Dada la escasa prevalencia de esta afección, y la afectación de los bordes quirúrgicos tras el tratamiento quirúrgico, consideramos necesario elaborar una revisión bibliográfica sobre el tumor desmoide en mama; etiología, clínica y tratamiento (AU)

We report the case of a 16-year-old patient with no relevant gynecologic history, who was diagnosed with a phyllodes tumor in the border between the lower and upper outer quadrants of the right breast. The patient was treated with a tumorectomy/lumpectomy, and after pathological study of the specimen, was diagnosed with a desmoid breast tumor. Given the rarity of this entity, and the positive microscopic surgical margins, we consider that a literature review of desmoid breast tumor (etiology, clinical presentation and treatment) is timely (AU)

Evisceración vaginal traumática en mujer posmenopáusica / Traumatic vaginal evisceration in a postmenopausal woman

La evisceración vaginal es una emergencia médica rara que se presenta con mayor frecuencia en mujeres posmenopáusicas con antecedente de cirugía pélvica o vaginal, especialmente histerectomía, y cierta disfunción del suelo pélvico. Sin embargo, la evisceración espontánea vaginal sin antecedentes de cirugía previa en este tipo de pacientes es aún más infrecuente. Se describe a continuación un caso de evisceración vaginal traumática en una mujer posmenopáusica (AU)

Vaginal evisceration is a rare medical emergency that usually occurs in postmenopausal women with a history of pelvic or vaginal surgery, especially hysterectomy, and some pelvic floor dysfunction. Spontaneous vaginal evisceration without previous surgery in these patients is even more uncommon. We discuss a case of spontaneous vaginal evisceration after vaginal trauma in a postmenopausal woman (AU9

Cáncer neuroendocrino de mama. A propósito de un caso / Neuroendocrine breast cancer. A case report

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Survey of European patients assessing their own noncancer chronic pain: results from Spain.

OBJECTIVE: As part of the CHANGE PAIN international health campaign to improve pain management, patient surveys are being undertaken to explore how patients perceive their noncancer chronic pain and how they deal with it. RESEARCH DESIGN AND METHODS: In Spain, 8695 patients completed this survey. The cross-sectional data were provided during routine visits to 893 physicians from different specialties. Pain intensity was assessed on two scales: a 5-point verbal rating scale (VRS) and an 11-point numerical rating scale (NRS). RESULTS: Most patients were women (57%) in their late adulthood (45-64 years; 34%) or elderly (65 years or older; 53%). Pain duration of one year or longer was frequent (65%). Combined pharmacological treatment (51%) was more common than monotherapy (33%). The most frequently prescribed agents were nonsteroidal anti-inflammatory drugs, to be taken alone (18%) or together with weak opioids (15%), followed by weak (7%) or potent (6%) opioids in monotherapy; but there were many different treatments prescribed. Most patients had moderate (47%) or severe/extreme (34%) VRS rated pain. The mean intensity in the NRS was of 5.7 over 10. Many patients had pain above the level they could tolerate (38%) and most (55%) were not satisfied with their therapy. Their main goals were pain relief and reduction of side effects. KEY LIMITATIONS: Causal inductions are not possible in a cross-sectional research like this. Other clinically meaningful outcome measures in patients with chronic pain, such as patients' quality of life, were not gathered. CONCLUSIONS: Chronic noncancer pain management is poor. The uncoupling of VRS and NRS pain ratings reveals the high subjectivity of the pain experience, whilst the wide variation in treatment choices indicates that an optimal management strategy remains to be defined. Advances might be attained by boosting communication to tailor treatments to individual patients' perceptions.

Markovian approximation in a coarse-grained description of atomic systems.

The Markovian assumption stating that memory effects can be neglected is a crucial assumption in the theory of coarse-graining. We investigate the coarse-graining of a one-dimensional chain of oscillators where the atoms are grouped into clusters or blobs. When the interaction between oscillators is through Hookean springs, the cluster dynamics is non-Markovian, as has been recently noted by Cubero and Yaliraki [J. Chem. Phys. 122, 03418 (2005)]. When the oscillators interact through a nonlinear potential of the Lennard-Jones type, the dynamics turns out to be Markovian. The different behavior in both types of interactions is attributed to the persistence of sound waves in the harmonic case, which are strongly suppressed in the nonlinear case.