Quarry rock reef design features influence fish assemblage structure across a systematically heterogenous restoration reef.

To restore an area of temperate rocky-reef degraded by sedimentation, scour, and burial, a large quarry rock reef, the Palos Verdes Restoration Reef (PVR), was built with a heterogenous design including high relief elements intended to increase fish biomass productivity and support a diverse reef community. The replicated design features provide a unique opportunity to study the effects of reef design on fish habitat use patterns. To determine how submodule scale habitat features are associated with variation in the assemblage structure of eleven focal fish species on the PVR we conducted diver-operated stereo-video surveys on all 18 PVR modules 9-13 months after construction. The highest mean densities of most focal fish species and highest total fish densities were observed on high and medium-relief reef submodules and their adjacent ecotones positioned on the offshore sides or ends of modules. These included the most abundant species on the PVR, the zooplanktivorous Blacksmith (Chromis punctipinnis), as well as the fishery species Kelp Bass (Paralabrax clathratus) and California Sheephead (Bodianus pulcher). On the inshore side of parallel modules, the reef and ecotone transects on low and medium relief submodules exhibited the lowest total mean fish densities, and consistently lower mean focal fish species densities. Focal fish species assemblages also differed between the reef and sand-rock ecotone transects. Reef-resident planktivorous fishes likely contribute to reef primary and secondary productivity through consumer mediated nutrient transport and are an important consideration in restoration reef design. Future reef restoration designs should consider incorporating replicated heterogeneous design features including the placement of higher relief elements relative to shore and current patterns as a special consideration for providing habitat for planktivorous reef-resident fishes.

Altered Amplitude of Low-Frequency Fluctuations of rs-fMRI Signal followed by rTMS Analgesic Effects in Non-Specific Chronic Low Back Pain (CLBP) Patients.

Background: Non-specific chronic low back pain (CLBP) is a common painful condition and is responsible for different physical disorders. Despite alternative therapies, patients still suffer from persistent pain. Repetitive transcranial magnetic stimulation (rTMS) has provided much evidence of pain reduction, but results have not been examined deeply in CLBP symptoms. Objective: The analgesic effect of rTMS in non-specific CLBP patients was evaluated by the amplitude of low-frequency fluctuation (ALFF) analysis in resting-state fMRI. Material and Methods: In this experimental study, fifteen non-specific CLBP participants (46.87±10.89 years) received 20 Hz rTMS over the motor cortex. The pain intensity and brain functional scan were obtained during pre and post-stimulation for all participants. The ALFF maps of the brain in two scan sessions were identified and the percentage of pain reduction (PPR%) was determined using paired t-test. Also, correlation analysis was used to find a relationship between ALFFs and pain intensity. Results: Pain intensity was significantly reduced after induced-rTMS in non-specific CLBP (36.22%±13.28, P<0.05). Positive correlation was found between ALFF in the insula (INS) and pain intensity (rpre-rTMS=0.59, rpost-rTMS=0.58) while ALFF in medial prefrontal cortex (mPFC) and pain intensity had negatively correlated (rpre-rTMS=-0.54, rpost-rTMS=-0.56) (P<0.05). ALFF increased in mPFC while INS, thalamus (THA), and supplementary motor area (SMA) showed decremental ALFF followed by rTMS. Conclusion: This study demonstrated that ALFF in INS, THA, mPFC, and SMA is associated with CLBP symptoms and analgesic effects of rTMS. ALFF potentially seems to be a proper objective neuroimaging parameter to link spontaneous brain activity with pain intensity in non-specific CLBP patients.

Ultrasound-Guided Aspiration of a Paralabral Cyst: A Novel Technique for Management.

Paralabral cysts of the shoulder joint, though rare, often arise from underlying shoulder pathologies such as labral tears and posterior shoulder capsule instability. These mucin-filled cysts can compress surrounding nerves, particularly the suprascapular nerve, leading to muscle weakness, joint instability, and limited range of motion (ROM). Traditionally, management involves magnetic resonance imaging (MRI) diagnosis followed by surgical repair of the underlying pathology and cyst removal. However, less invasive treatments like ultrasound-guided cyst aspiration have shown promising results. In this case, a 48-year-old male with a history of myasthenia gravis (MG) and chronic bilateral shoulder pain presented with worsening right shoulder pain and weakness during exercise. His extensive treatment history included orthopedic surgery on his left shoulder and multiple Platelet-Rich-Plasma (PRP) injections, which offered only temporary relief. After an MRI confirmed a 2.5 cm paralabral cyst compressing the suprascapular nerve, the patient, opting for a non-surgical approach, underwent ultrasound-guided aspiration. The procedure involved a single aspiration session using a 22-gauge needle under real-time ultrasound guidance, with the complete evacuation of cystic fluid. Follow-up at three and six months revealed complete symptom resolution, with a full recovery of muscle strength and shoulder mobility. No complications were observed, and there was no recurrence of the cyst on follow-up imaging. While surgery remains the gold standard, this case underscores the effectiveness of minimally invasive techniques like ultrasound-guided aspiration, which can offer comparable outcomes with potentially lower recurrence rates and reduced morbidity. Studies support image-guided cyst aspiration as a cost-effective, patient-preferred alternative to surgery, with broader implications for clinical practice in managing similar cases. In summary, paralabral cysts present a complex clinical challenge that benefits from individualized treatment plans. In addition, this case highlights the importance of inter-professional communication and patient-centered care in exploring viable alternatives to surgery, such as ultrasound-guided aspiration, which provides significant symptom relief and functional improvement.

Drinking motives link positive and negative life events to problematic alcohol use during the COVID-19 pandemic: a longitudinal study.

PURPOSE: Stressful life events are associated with problematic drinking, and alcohol misuse has been exacerbated during the coronavirus disease 2019 (COVID-19) pandemic. While coping motives may account for this association, positive life events (PLEs) and enhancement motives are understudied. To address these gaps, we examined the associations of history of alcohol use disorder (AUD), negative life events (NLEs), and PLEs with problematic alcohol use and tested coping and enhancement motives as mediators. METHODS: The sample included baseline and follow-up data from 241 participants enrolled in the National Institute on Alcohol Abuse and Alcoholism COVID-19 Pandemic Impact on Alcohol Study. Endorsements of past year PLEs and NLEs and their associations with problematic alcohol use were examined. Among the 202 current drinkers, path analyses tested mediational pathways via coping and enhancement motives. RESULTS: The top two PLEs were change in work conditions (21.6%) and taking a vacation (20.3%). The top two NLEs were change in social activities (36.5%) and major change in recreation (26.6%). Individuals with a history of AUD and those who experienced more NLEs reported higher coping and enhancement motives, which were associated with higher problematic alcohol use. Individuals who experienced more PLEs reported lower coping motives, which was associated with lower problematic alcohol use. CONCLUSIONS: Besides coping motives, enhancement motives were also associated with pandemic problematic alcohol use. Alcohol interventions targeting reward- and relief-driven drinking patterns may be beneficial to individuals with a history of AUD and those who experienced more NLEs. More research is needed to study PLEs which may help inform the development of strength-based alcohol interventions.

Assessing the limitations of relief-based algorithms in detecting higher-order interactions.

BACKGROUND: Epistasis, the interaction between genetic loci where the effect of one locus is influenced by one or more other loci, plays a crucial role in the genetic architecture of complex traits. However, as the number of loci considered increases, the investigation of epistasis becomes exponentially more complex, making the selection of key features vital for effective downstream analyses. Relief-Based Algorithms (RBAs) are often employed for this purpose due to their reputation as "interaction-sensitive" algorithms and uniquely non-exhaustive approach. However, the limitations of RBAs in detecting interactions, particularly those involving multiple loci, have not been thoroughly defined. This study seeks to address this gap by evaluating the efficiency of RBAs in detecting higher-order epistatic interactions. Motivated by previous findings that suggest some RBAs may rank predictive features involved in higher-order epistasis negatively, we explore the potential of absolute value ranking of RBA feature weights as an alternative approach for capturing complex interactions. In this study, we assess the performance of ReliefF, MultiSURF, and MultiSURFstar on simulated genetic datasets that model various patterns of genotype-phenotype associations, including 2-way to 5-way genetic interactions, and compare their performance to two control methods: a random shuffle and mutual information. RESULTS: Our findings indicate that while RBAs effectively identify lower-order (2 to 3-way) interactions, their capability to detect higher-order interactions is significantly limited, primarily by large feature count but also by signal noise. Specifically, we observe that RBAs are successful in detecting fully penetrant 4-way XOR interactions using an absolute value ranking approach, but this is restricted to datasets with only 20 total features. CONCLUSIONS: These results highlight the inherent limitations of current RBAs and underscore the need for the development of Relief-based approaches with enhanced detection capabilities for the investigation of epistasis, particularly in datasets with large feature counts and complex higher-order interactions.

High-Frequency 10-kHz Spinal Cord Stimulation Provides Long-term (24-Month) Improvements in Diabetes-Related Pain and Quality of Life for Patients with Painful Diabetic Neuropathy.

BACKGROUND: The SENZA-PDN study evaluated high-frequency 10-kHz spinal cord stimulation (SCS) for the treatment of painful diabetic neuropathy (PDN). Over 24 months, 10-kHz SCS provided sustained pain relief and improved health-related quality of life. This report presents additional outcomes from the SENZA-PDN study, focusing on diabetes-related pain and quality of life outcomes. METHODS: The SENZA-PDN study randomized 216 participants with refractory PDN to receive either conventional medical management (CMM) or 10-kHz SCS plus CMM (10-kHz SCS + CMM), allowing crossover after six months if pain relief was insufficient. Postimplantation assessments at 24 months were completed by 142 participants with a permanent 10-kHz SCS implant, comprising 84 initial and 58 crossover recipients. Measures included the Brief Pain Inventory for Diabetic Peripheral Neuropathy (BPI-DPN), Diabetes-Related Quality of Life (DQOL), Global Assessment of Functioning (GAF), and treatment satisfaction. RESULTS: Over 24 months, 10-kHz SCS treatment significantly reduced pain severity by 66.9% (P < .001; BPI-DPN) and pain interference with mood and daily activities by 65.8% (P < .001; BPI-DPN). Significant improvements were also observed in overall DQOL score (P < .001) and GAF score (P < .001), and 91.5% of participants reported satisfaction with treatment. CONCLUSIONS: High-frequency 10-kHz SCS significantly decreased pain severity and provided additional clinically meaningful improvements in DQOL and overall functioning for patients with PDN. The robust and sustained benefits over 24 months, coupled with high participant satisfaction, highlight that 10-kHz SCS is an efficacious and comprehensive therapy for patients with PDN.

Single Institutional Cross-Sectional Phone Survey Study: Evaluation of Causes for Loss to Follow-up After Spinal Cord Stimulator Implantation.

BACKGROUND: Spinal cord stimulation (SCS) is often an option of last resort for patients with post-laminectomy syndrome or an alternative option for patients with complex regional pain syndrome, chronic nonsurgical low back pain, or painful diabetic peripheral neuropathy when conservative management has failed. Although SCS is a helpful option, it is not without complications that can frequently lead to explantation of the SCS device and dissatisfaction with the treatment. Furthermore, as with any technology, SCS has potential issues that may lead to patient frustration and ultimately result in patient noncompliance and lack of follow-up visits. OBJECTIVES: The goals of this study are to explore the magnitude of and reasons for patient loss to follow-up after SCS device implantation. STUDY DESIGN: A cross-sectional phone survey. SETTING: A tertiary-care academic hospital. METHODS: A cross-sectional phone survey was performed on 49 patients who were deemed lost to follow-up when they did not return to the clinic one month after being implanted with permanent SCS devices at Beth Israel Deaconess Medical Center. Patients were administered an institutional review board-approved questionnaire exploring their reasons for not returning to the clinic. RESULTS: Over a 5-year period, 257 patients underwent full implantation of an SCS device. Of the 49 patients lost to follow-up, 24 were able to be contacted, and they completed the questionnaire. Twenty of the patients continued to use the SCS device but were lost to follow-up for the following reasons: 58% (14/24) due to improvement of pain, 13% (3/24) due to minimal improvement in pain control, 4% (1/24) due to other urgent health conditions, and 8% (2/24) due to patient noncompliance and missing follow-up appointments (4/24). Four patients discontinued using the SCS device after an average of 1.5 years +/- one year, 12% (3/24) due to inadequate pain control and 4% (1/24) due to inability to recharge the device (1/24). Of these patients, 2 of the 4 contacted their SCS representatives for help with troubleshooting prior to discontinuation. None of the patients was explanted. LIMITATIONS: The main limitation of this study was the incompletion rate, which was 51.0% (25 out of 49 patients). CONCLUSIONS: This paper, the first cross-sectional study of loss to follow-up among patients who are implanted with SCS devices, identifies that up to 19% of patients are quickly lost to follow-up after implantation. Only half of the patients in this study could be reached, with most successfully using their device for meaningful pain control, but a substantial number of patients likely required additional device optimization for pain relief.

Safety and Efficacy of Axon Therapy (SEAT Study), Utilizing Magnetic Peripheral Nerve Stimulation (mPNS) for Treatment of Neuropathic Pain.

Background: Many of the current treatments for chronic neuropathic pain have variable effectiveness and known side effects. Given the prevalence of this type of intractable pain (3-17% of general population), additional therapeutic non-invasive approaches are desired. Magnetic Peripheral Nerve Stimulation (mPNS) delivered at 0.5Hz provides an effective pain relief without side effects. The objective of this randomized, controlled, multi-site clinical trial was to compare long-term safety and efficacy of mPNS in patients with chronic, intractable, post-traumatic or post-surgical neuropathic pain to comprehensive Conventional Medical Management (CMM). Methods: A total of 65 patients with post-traumatic, post-surgical neuropathy were treated within a multicenter, randomized, clinical trial comparing the safety and effectiveness of mPNS + CMM to CMM alone. Patients were randomized 1:1 and followed through 90 days. The primary endpoint is a proportion of responders, 50% or greater reduction in pain at Day 90. The secondary endpoints included the European Quality of Life 5 Dimensions 3 Level (EQ-5D-3L) and Patient Global Impression of Change (PGIC). Results: At 3 months, 71% of subjects were considered responders (>50% pain relief) in the mPNS + CMM group vs 13% of subjects in the CMM group. The mPNS + CMM group had a mean reduction in VAS scores at Day 90 of 3.8 points (>50% reduction), while CMM showed less than a 1-point (0.7 point) mean reduction or ~10% reduction (p < 0.0001). The EQ-5D-3L score increased in the mPNS + CMM study group, whereas the CMM group showed no improvement in EQ-5D-3L at Day 90. PGIC responder rates were 80.6% and 4.3% at Day 90 for mPNS + CMM and CMM groups, respectively. Conclusion: mPNS + CMM was superior to CMM in a randomized prospective study when used for treatment of post-traumatic, post-surgical neuropathy. Due to the lack of other effective non-invasive treatments for neuropathic pain, mPNS should be considered much earlier in the treatment algorithm.

Fatigue and Corrosion Evaluation of L-PBF 316L Stainless Steel Having Undergone a Self-Terminating Etching Process for Surface Finish Improvement.

The poor surface finish of as-printed (AP) laser powder bed fusion (L-PBF) 316L stainless steels has detrimental impacts on the resulting fatigue and corrosion performance. One postprocessing method, a self-terminating etching process (STEP), can improve the surface finish of parts up to 76%, but the resulting effects on fatigue life and corrosion reliability remain unknown. This work evaluates the effect of the STEP on the fatigue and corrosion performance of L-PBF 316L. In addition, to determine the influence of changing the microstructures from the as-built condition, specimens having undergone a pre-STEP stress relief (SR + STEP) heat treatment and a pre-STEP solution anneal (SA + STEP) were evaluated. The results showed that a pre-STEP SR resulted in the best Sa roughness, while a pre-STEP SA had the biggest improvement in Sv roughness. Despite Sv roughness being a major indicator of fatigue performance, the coarse grains and internal porosity in the SA specimens resulted in the poorest fatigue performance. The SR + STEP specimens' fatigue lives were 10 × higher than the AP samples under a load of 275 MPa and 2-3 × higher under a 350 MPa load. The SR + STEP specimen also had the best corrosion performance in a sodium chloride electrolyte due to the smoother surface and least remnant surface carbides.

The dawn of a sexual assault relief center: A 12-year fact-finding survey of victims of sexual assault conducted since 2010 by SACHICO, Japan's first rape crisis center.

OBJECTIVE: In Japan, amidst insufficient legal provisions and governmental support, in 2010, the first rape crisis center, the Sexual Assault Crisis Healing Intervention Center Osaka (SACHICO) was established. We compared SACHICO visitor data from 2010 to 2021 with National Police Agency statistics to clarify the current situation of sexual assault victims in Japan and considered future issues for Japan to address. METHODS: This study was a cross-sectional study that analyzed the data described below. All visitations to SACHICO between April 2010 and December 2021 were considered targets for data totaling. Data on crime statistics were gathered from the official governmental statistics portal site. RESULTS: A total of 12 036 visitations occurred, of which 3189 were first-time consultations; 3100 initial medical examinations were conducted, and no medical examination was conducted in the remaining 89 cases (2.7%). The number of initial medical examinations increased 3.7 times from 2010 to 2021. Victims under the age of 19 comprised 60% of the total number of initial medical examinations (1863/3100). The reporting rate for all 3100 initial medical examinations was only 31.3% (969/3100) of the cases. The proportion of forcible sexual intercourse versus forcible indecency were the converse of those observed among acknowledged cases nationwide and in Osaka Prefecture. For several years, the number of initial medical consultations at SACHICO has exceeded that of acknowledged cases in Osaka Prefecture. CONCLUSION: Support for victims of sexual assault in Japan is still insufficient. It is necessary to strengthen the system of rape crisis centers system to realize an unbroken chain of support for victims.

Long-Term Follow-Up Regarding Pain Relief, Fertility, and Re-Operation after Surgery for Deep Endometriosis.

Background: Endometriosis is known to be a common chronic disease that often affects the quality of life of patients. Especially for deep endometriosis (DE), the most challenging form of the disease, surgery remains an important component of treatment. However, long-term outcomes after surgery are poorly studied. Therefore, we aimed to evaluate the postoperative clinical course of women with DE who underwent surgery, particularly with regard to pain relief, fertility, and re-operations. Methods: Thus, women who underwent surgical treatment for DE between 2005 and 2015 were included in this retrospective questionnaire-based analysis. Results: A total of 87.0% of the patients who underwent surgery for pain reported a postoperative relief of their complaints. Moreover, 44.6% even stated that they were free of pain at the time of the questionnaire. Patients who underwent surgery for infertility and tried to become pregnant postoperatively gave birth to a child in 45.9% of cases. Approximately one-third of the patients had to undergo another surgery because of endometriosis-related symptoms. The main reasons for re-operation were pain and infertility. The median time to re-operation was 2.1 years. Conclusions: In this extraordinarily long follow-up with a remarkable response rate, we show that surgical treatment of DE leads to pain relief and improved fertility in most cases. However, the risk of recurrence and the need for re-operation remains remarkable.

Stress-induced overeating behaviors explained from a (transitory) relief-learning perspective.

People use various behaviors to cope with stressful events. These behaviors are mostly adaptive, as they allow a successful release of stress without impacting other aspects of life: How nice is it to have a break with a few spoons of that favorite ice cream during a hectic working day? However, when excessive consumption of high-sugar/salt ultra-processed food becomes the gateway to find relief from stress, eating loses this adaptive function and may escalate to binge eating, lead to obesity, and other medical conditions linked to overweight. Several etiological models attempt to explain stress-induced eating and excessive overeating behaviors characterizing these clinical conditions. The popular Emotional Eating Theory proposes that stress-related (over-)eating, a major predictor of obesity and diagnosed binge eating disorders, develops based on negative reinforcement learning since food consumption regulates the negative affective state associated with stressful circumstances. Differently, the prominent Incentive Sensitization Theory explains overeating, binge eating disorders (including bulimia), and obesity in terms of excessive amplification of reward 'wanting', which is thought to emerge from overexposure to obesogenic (food)cues. The several studies oriented by these theories have paved the way to better understand stress-related (over-)eating and its clinical excesses. However, a deep mechanistic understanding of how and why stress-induced (over-)eating can escalate till clinical forms of overeating remain elusive. A well-funded connection of the mechanisms proposed by the Emotional Eating Theory and the Incentive Sensitization Theory might address this etiological open question. To avoid erroneous arguments, it is however essential to first address the internal theoretical and methodological shortcomings of each theory and connected studies. These shortcomings stem from conceptual fallacies and poorly implemented designs, which might partially explain the 'high variability and low replicability' problem of empirical findings. Next, the formulation of a new integrative model could provide fresh insight into the deep learning and biological mechanisms of this escalation. A successful formalization of this model could then create the much-needed impact in clinical and preventive research since excessive overeating is a behavior hard to change once established. In this opinion paper, I propose to apply recent insights we gathered on the role of relief from the field of safety learning to stress (over-)eating. I will present a new relief-based model that, as a starting point, has the potential to connect the Emotional Eating Theory with the Incentive Sensitization Theory, setting the base for more integrative science.

Assessing the Limitations of Relief-Based Algorithms in Detecting Higher-Order Interactions.

Background: The investigation of epistasis becomes increasingly complex as more loci are considered due to the exponential expansion of possible interactions. Consequently, selecting key features that influence epistatic interactions is crucial for effective downstream analyses. Recognizing this challenge, this study investigates the efficiency of Relief-Based Algorithms (RBAs) in detecting higher-order epistatic interactions, which may be critical for understanding the genetic architecture of complex traits. RBAs are uniquely non-exhaustive, eliminating the need to construct features for every possible interaction and thus improving computational tractability. Motivated by previous research indicating that some RBAs rank predictive features involved in higher-order epistasis as highly negative, we explore the utility of absolute value ranking of RBA feature weights as an alternative method to capture complex interactions. We evaluate ReliefF, MultiSURF, and MultiSURFstar on simulated genetic datasets that model various patterns of genotype-phenotype associations, including 2-way to 5-way genetic interactions, and compare their performance to two control methods: a random shuffle and mutual information. Results: Our findings indicate that while RBAs effectively identify lower-order (2 to 3-way) interactions, their capability to detect higher-order interactions is significantly limited, primarily by large feature count but also by signal noise. Specifically, we observe that RBAs are successful in detecting fully penetrant 4-way XOR interactions using an absolute value ranking approach, but this is restricted to datasets with a minimal number of total features. Conclusions: These results highlight the inherent limitations of current RBAs and underscore the need for enhanced detection capabilities for the investigation of epistasis, particularly in datasets with large feature counts and complex higher-order interactions.

Nanozyme Decorated Metal-Organic Framework Nanosheet for Enhanced Photodynamic Therapy Against Hypoxic Tumor.

Introduction: Photodynamic therapy (PDT) has attracted increasing attention in the clinical treatment of epidermal and luminal tumors. However, the PDT efficacy in practice is severely impeded by tumor hypoxia and the adverse factors associated with hydrophobic photosensitizers (PSs), including low delivery capacity, poor photoactivity and limited ROS diffusion. In this study, Pt nanozymes decorated two-dimensional (2D) porphyrin metal-organic framework (MOF) nanosheets (PMOF@HA) were fabricated and investigated to conquer the obstacles of PDT against hypoxic tumors. Materials and Methods: PMOF@HA was synthesized by the coordination of transition metal iron (Zr4+) and PS (TCPP), in situ generation of Pt nanozyme and surface modification with hyaluronic acid (HA). The abilities of hypoxic relief and ROS generation were evaluated by detecting the changes of O2 and 1O2 concentration. The cellular uptake was investigated using flow cytometry and confocal laser scanning microscopy. The SMMC-7721 cells and the subcutaneous tumor-bearing mice were used to demonstrate the PDT efficacy of PMOF@HA in vitro and in vivo, respectively. Results: Benefiting from the 2D structure and inherent properties of MOF materials, the prepared PMOF@HA could not only serve as nano-PS with high PS loading but also ensure the rational distance between PS molecules to avoid aggregation-induced quenching, enhance the photosensitive activity and promote the rapid diffusion of generated radical oxide species (ROS). Meanwhile, Pt nanozymes with catalase-like activity effectively catalyzed intratumoral overproduced H2O2 into O2 to alleviate tumor hypoxia. Additionally, PMOF@HA, with the help of externally coated HA, significantly improved the stability and increased the cell uptake by CD44 overexpressed tumor cells to strengthen O2 self-supply and PDT efficacy. Conclusion: This study provided a new strategy of integrating 2D porphyrin MOF nanosheets with nanozymes to conquer the obstacles of PDT against hypoxic tumors.

Effect of nicotine mouth spray on urges to vape: A randomized, placebo-controlled, pharmacodynamic clinical trial in exclusive e-cigarette users.

AIMS: To determine whether nicotine mouth spray provides rapid and prolonged relief of urges to vape and measure the steady-state plasma nicotine levels during vaping and ad libitum mouth spray usage in e-cigarette users. DESIGN: Randomized, parallel group, double-blind trial. SETTING: Single site at Hammersmith Medicines Research Ltd (HMR), London, UK. PARTICIPANTS: 216 (25.9% females, average age 27.6 ± 7.63 [standard deviation, SD]) exclusive vapers who used their e-cigarette within 30 minutes of waking up and had vaped about 2 years on average. INTERVENTIONS: Two sprays of 1 mg nicotine mouth spray (Nicorette QuickMist Freshmint, n = 109), or placebo (identical in appearance and presentation, n = 107). MEASUREMENTS: Urge to vape was rated on a 100 mm visual analogue scale before and repeatedly for 2 hours after administration. The primary outcome measured average change from baseline in urges to vape ratings during the first hour. FINDINGS: Nicotine mouth spray achieved statistically significantly greater reductions in urges to vape than placebo from the first assessment point at 30 seconds to 1 hour, when the estimated mean treatment difference was 11.90 mm (95% confidence interval [CI] = 6.86-16.95, P < 0.001). The integrated urge to vape over 11 hours ad libitum usage showed a statistically significant benefit compared with placebo (2.00 [0.88 SD] vs 2.51 [0.84 SD], P < 0.001). Mean steady-state plasma nicotine concentrations were lower after nicotine mouth spray usage compared with vaping (6.22 [4.70 SD] ng/ml vs 9.91 [7.59 SD] ng/ml, respectively). Adverse events were more commonly reported in the nicotine mouth spray group and were mostly mild. CONCLUSIONS: Among regular e-cigarette users, nicotine mouth spray provided statistically significant and fast relief of urges to vape one hour after dosing. Nicotine mouth spray showed statistically significant reductions in urges to vape as soon as 30 seconds and up to 2 hours after dosing compared with placebo, and nicotine mouth spray was well-tolerated and safe.

Testicular self-examination: The role of anticipated relief and anticipated regret.

OBJECTIVE: Anticipated regret has been implicated in health-related decision-making. Recent work on influenza vaccination has suggested that anticipated relief, too, may influence individuals' decisions to engage in positive health behaviours. To explore these affective components further and address the generality of possible mechanisms underlying these associations, we examined whether anticipated relief and anticipated regret independently predict testicular self-examination (TSE) intention and behaviour. Given claims about differences in their nature and function, we distinguished between counterfactual relief (relief that a worse outcome did not obtain) and temporal relief (relief that an unpleasant experience is over). DESIGN: Prospective correlational. METHODS: At Time 1 (July 2022), 567 cis-gendered males were asked to complete measures of anticipated regret, anticipated counterfactual and temporal relief, measures of the Theory of Planned Behaviour and measures of anxiety and shame. One month later, the same participants were recontacted and asked about their engagement in TSE in the previous month. RESULTS: Anticipated counterfactual relief and anticipated regret are independent, positive, predictors of intention to engage in TSE and, indirectly, TSE behaviour itself. Interestingly, anticipated temporal relief was negatively associated with intention to engage in TSE and, indirectly, behaviour. CONCLUSIONS: Our results suggest that it may be the counterfactual nature of anticipated regret and anticipated relief that underlies their positive association with TSE and other health-promoting behaviours. Interventions designed to increase engagement in preventive health behaviours, such as TSE, may benefit from the consideration of both positively and negatively valenced counterfactual emotions.

Evaluation of Post-Operative Pain Management Techniques in Oral Surgery.

Objective: This prospective research directed to estimate the efficacy and safety of different post-operative pain management techniques in oral surgery subjects. Methods: Patients scheduled for various oral surgical procedures were recruited from a single oral surgery clinic between January 2022 and December 2023. Inclusion criteria encompassed adult subjects undergoing elective oral surgery under local or general anesthesia. Subjects were randomly assigned to one of three post-operative pain management protocols: Group A received standard analgesics, Group B received combination analgesics, and Group C received non-pharmacological interventions. Pain intensity scores, analgesic consumption, adverse events, and patient satisfaction were assessed at specified intervals post-operatively. Results: Non-pharmacological interventions demonstrated lower pain intensity scores and analgesic consumption compared to standard and combination analgesics. Additionally, the incidence of adverse events was lower in the non-pharmacological intervention group. Statistical analysis revealed significant differences in pain outcomes among the three groups. Conclusion: This prospective research suggests that non-pharmacological interventions may provide effective pain relief with fewer adverse events compared to traditional analgesics in post-operative oral surgery subjects. Implementation of multi-modal pain management approaches tailored to individual patient needs may improve overall pain control and enhance patient outcomes.

Neural adaptation of the reward system in primary dysmenorrhea.

Introduction: The brain's reward system (RS) reacts differently to pain and its alleviation. This study examined the correlation between RS activity and behavior during both painful and pain-free periods in individuals with primary dysmenorrhea (PDM) to elucidate their varying responses throughout the menstrual cycle. Methods: Ninety-two individuals with PDM and 90 control participants underwent resting-state functional magnetic resonance imaging (rsfMRI) scans during their menstrual and peri-ovulatory phases. Regional homogeneity (ReHo) and amplitude of low-frequency fluctuation (ALFF) analyses were used to evaluate RS responses. Psychological evaluations were conducted using the McGill Pain Questionnaire and the Pain Catastrophizing Scale. Results: ReHo analysis showed higher values in the left putamen and right amygdala of the PDM group during the peri-ovulatory phase compared to the menstrual phase. ALFF analysis revealed lower values in the putamen of the PDM group compared to controls, regardless of phase. ReHo and ALFF values in the putamen, amygdala, and nucleus accumbens were positively correlated with pain scales during menstruation, while ALFF values in the ventral tegmental area inversely correlated with pain intensity. Those with severe PDM (pain intensity ≥7) displayed distinct amygdala ALFF patterns between pain and pain-free phases. PDM participants also had lower ReHo values in the left insula during menstruation, with no direct correlation to pain compared to controls. Discussion: Our study highlights the pivotal role of the RS in dysmenorrhea management, exhibiting varied responses between menstrual discomfort and non-painful periods among individuals with PDM. During menstruation, the RS triggers mechanisms for pain avoidance and cognitive coping strategies, while it transitions to processing rewards during the peri-ovulatory phase. This demonstrates the flexibility of the RS in adapting to the recurring pain experienced by those with PDM.

Are changes in pain intensity related to changes in balance control in individuals with chronic non-specific low back pain? A systematic review and meta-analysis.

PURPOSE: The aim of this study is to summarize the evidence regarding whether pain reduction in individuals with chronic non-specific low back pain (CNSLBP) following conservative interventions is related to corresponding improvements in balance control. METHODS: Randomized controlled trials were identified from 5 databases (MEDLINE, Cochrane Library, Embase, Web of Science, and PsycINFO). Two reviewers independently screened and identified relevant studies that investigated the effects of nonsurgical or nonpharmacological CNSLBP treatments on both pain intensity and balance control. Meta-regression analyses were performed to establish the associations between post-treatment changes in these 2 variables. RESULTS: 31 studies involving 1280 participants with CNSLBP were included. Moderate-quality evidence suggested that pain reduction was associated with and explained 34-45 % of decreases in body sway, as measured by center-of-pressure (CoP) area and CoP velocity with eyes open. However, no significant association was observed between pain reduction and CoP area or velocity in anteroposterior/mediolateral directions. Similarly, there was no significant association between pain reduction and CoP distance or radius. Low-quality evidence indicated that pain relief explained a 15 % improvement in one-leg stance with eyes open but not in the eyes-closed condition. Additionally, very low-quality evidence suggested that pain relief explained a 44 % decrease in the static anteroposterior stability index with eyes closed but not in the eyes-open, mediolateral, or overall conditions. Furthermore, low-quality evidence indicated that reduced pain was associated with and accounted for 25-43 % of the improved composite and posteromedial scores of the star-excursion balance test, rather than the anterior and posterolateral scores. CONCLUSION: Depending on the type of balance assessment, pain relief following conservative interventions may slightly to moderately enhance balance control in individuals with CNSLBP. Clinicians should pay close attention to the balance control in patients with CNSLBP, particularly among older adults.

Exploring the Efficacy and Duration of Therapeutic Effects of a Novel Iliohypogastric and Ilioinguinal Ablation Approach: A Stepwise Radiofrequency Ablation Technique.

Radiofrequency ablation (RFA) targeting the iliohypogastric and ilioinguinal (IH/IL) nerves is a recognized treatment for lower abdominal neuropathic pain. Despite its effectiveness, RFA typically offers only a temporary reprieve, necessitating repeated procedures. RFA procedures of the IH/IL nerves have been well described but often result in patient non-compliance and commonly necessitate the use of increased sedation. This case report details an RFA technique as a novel therapeutic technique for managing neuropathic pain associated with IH and IL pain. The technique described was conducted on a patient with complex pain and profound hyperalgesia with remarkable patient compliance and, more importantly, with reduced sedation. This case report delves into the progressive interventions employed by this novel technique in a patient being treated for IH/IL neuralgia. This case report describes increased patient compliance and potentially increased safety profile associated with this innovative RFA technique in comparison to traditional RFA and steroid injection. The patient, whose pain was unresponsive to standard treatments, was thoroughly assessed and underwent multiple failed interventions requiring sedation before the novel RFA technique was considered. We describe the patient's progression through various treatments, illustrating the benefits of this novel RFA method over the established ones. The discussion highlights the advantages of the new technique in terms of its effectiveness and the duration of its pain relief, offering valuable insights into the pain management field. This case contributes to the growing array of therapeutic strategies in pain medicine, potentially enhancing patient outcomes for those with IH/IL neuropathic pain.