The Role of Resistance Training Dosing on Pain and Physical Function in Individuals With Knee Osteoarthritis: A Systematic Review.

CONTEXT: Dosing parameters are needed to ensure the best practice guidelines for knee osteoarthritis. OBJECTIVE: To determine whether resistance training affects pain and physical function in individuals with knee osteoarthritis, and whether a dose-response relationship exists. Second, we will investigate whether the effects are influenced by Kellgren-Lawrence grade or location of osteoarthritis. DATA SOURCES: A search for randomized controlled trials was conducted in MEDLINE, Embase, and CINAHL, from their inception dates, between November 1, 2018, and January 15, 2019. Keywords included knee osteoarthritis, knee joint, resistance training, strength training, and weight lifting. STUDY SELECTION: Inclusion criteria were randomized controlled trials reporting changes in pain and physical function on humans with knee osteoarthritis comparing resistance training interventions with no intervention. Two reviewers screened 471 abstracts; 12 of the 13 studies assessed were included. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 2. DATA EXTRACTION: Mean baseline and follow-up Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and standard deviations were extracted to calculate the standard mean difference. Articles were assessed for methodological quality using the CONSORT (Consolidated Standards of Reporting Trials) 2010 scale and Cochrane Collaboration tool for assessing risk of bias. RESULTS: The 12 included studies had high methodological quality. Of these, 11 studies revealed that resistance training improved pain and/or physical function. The most common regimen was a 30- to 60-minute session of 2 to 3 sets of 8 to 12 repetitions with an initial resistance of 50% to 60% of maximum resistance that progressed over 3 sessions per week for 24 weeks. Seven studies reported Kellgren-Lawrence grade, and 4 studies included osteoarthritis location. CONCLUSION: Resistance training improves pain and physical function in knee osteoarthritis. Large effect sizes were associated with 24 total sessions and 8- to 12-week duration. No optimal number of repetitions, maximum strength, or frequency of sets or repetitions was found. No trends were identified between outcomes and location or Kellgren-Lawrence grade of osteoarthritis.

High-Frequency Stimulation of the Subthalamic Nucleus Blocks Compulsive-Like Re-Escalation of Heroin Taking in Rats.

Opioid addiction, including addiction to heroin, has markedly increased in the past decade. The cost and pervasiveness of heroin addiction, including resistance to recovery from addiction, provide a compelling basis for developing novel therapeutic strategies. Deep brain stimulation may represent a viable alternative strategy for the treatment of intractable heroin addiction, particularly in individuals who are resistant to traditional therapies. Here we provide preclinical evidence of the therapeutic potential of high-frequency stimulation of the subthalamic nucleus (STN HFS) for heroin addiction. STN HFS prevented the re-escalation of heroin intake after abstinence in rats with extended access to heroin, an animal model of compulsive heroin taking. STN HFS inhibited key brain regions, including the substantia nigra, entopeduncular nucleus, and nucleus accumbens shell measured using brain mapping analyses of immediate-early gene expression and produced a robust silencing of STN neurons as measured using whole-cell recording ex vivo. These results warrant further investigation to examine the therapeutic effects that STN HFS may have on relapse in humans with heroin addiction.

Utilidad del strain bidimensional longitudinal por speckle tracking en pacientes con enfermedad de Chagas-Mazza sin cardiopatía demostrada / Usefulness of two-dimensional longitudinal strain by speckle tracking in patients with Chagas disease without evident heart disease / Utilidade de strain bidimensional longitudinal por speckle tracking em pacientes com doença de Chagas sem evidência de doença cardíaca

Introducción. La enfermedad de Chagas es una causa importante de insuficiencia cardíaca y su identificación precoz puede ayudar a identificar pacientes en riesgo de progresión de la enfermedad. El strain bidimensional longitudinal (Str2D) podría ser una herramienta útil para detectar disfunción ventricular izquierda incipiente. Objetivos. Analizar si el strain puede detectar alteraciones en pacientes asintomáticos y sin patología demostrable por los métodos convencionales en la enfermedad de Chagas. Materiales y métodos. Estudio transversal de 45 pacientes menores de 65 años de zona rural con enfermedad de Chagas, sin patología demostrada frente a 33 individuos sanos (controles). En todos realizamos serología por dos métodos, examen clínico, electrocardiograma y eco-Doppler cardíaco: diámetro diastólico del ventrículo izquierdo (DDVI), área auricular izquierda (AI), fracción de eyección del ventrículo izquierdo (Fey) por Simpson, excursión sistólica del plano del anillo tricuspídeo (TAPSE), E/A mitral (E/A), E/e', S tisular (S´) de ventrículo izquierdo (VI) y ventrículo derecho (VD), Str2D de cada segmento del VI y strain global. Estadística: variables cuantitativas de distribución normal se compararon mediante test de t y cualitativas con test de chi cuadrado. Variabilidad intra e interobservador por r de Pearson y coeficiente de correlación intraclase.Resultados. Edad, sexo y eco-Doppler convencional (DDVI, Fey, AI, TAPSE, E/A, E/e') no mostraron diferencias estadísticamente significativas. El strain global y el strain de los segmentos apicales del VI evidenciaron diferencias significativas entre pacientes con enfermedad de Chagas sin cardiopatía demostrada (SCD) y controles, aunque dichos valores se encuadran dentro de rangos considerados fisiológicos. Variabilidad intraobservador del strain global (r de Pearson: 0,93 y CCI: 0,93) e interobservador (coeficiente r de Pearson 0,89 y un CCI: 0,88). Conclusiones. Los hallazgos del estudio muestran reducción significativa del strain longitudinal global y distal, compatible con un daño miocárdico incipiente en los pacientes con serología positiva para enfermedad de Chagas sin cardiopatía demostrada, hipótesis de trabajo que sólo el tiempo y un prolijo seguimiento podrán confirmar.

Introduction. Chagas disease is a major cause of heart failure and early identification may help identify patients at risk for disease progression. The two-dimensional longitudinal strain (Str2D) could be a useful tool for detecting incipient left ventricular dysfunction. Objectives. Analyze whether longitudinal dimensional strain can detect abnormalities in asymptomatic patients without demonstrable pathology by conventional methods in Chagas disease. Materials and Methods. Cross-sectional study of 45 patients under age 65 years in an endemic rural area with Chagas disease without proven pathology (non evident cardiopathy: NEC) versus 33 control patients. In all patients study was made by two serologic methods, clinical examination, electrocardiogram and Doppler ultrasound of the heart: diastolic diameter of the left ventricle (LVDD), left atrial area (LAA), left ventricle ejection fraction (Fey) by Simpson, excursion of tricuspid ring (TAPSE), E/A mitral ratio (E/A), E/e' ratio, S tissue (S') of left ventricular (LV) and right ventricular (RV), Str2D of each segment LV and global strain. Statistics: Normal distribution quantitative variables were compared using t test and qualitative variables with chi square test. Intra- and inter-observer variability for r Pearson and intra-class correlation coefficient (ICC). Results. Age, sex and conventional Doppler echocardiography (LVDD, Fey, LAA, TAPSE, E/A, E/e') showed no statistically significant differences. Global strain and strain of the apical LV segments showed significant differences between patients with Chagas disease without proven disease and their controls, although these values fall within ranges considered physiological. Intraobserver variability of global strain (Pearson's r 0.93 and ICC: 0.93) and interobserver (Pearson coefficient r of 0.89 and an ICC: 0.88). Conclusions. In a group of asymptomatic patients with Chagas disease without apparent cardiac involvement (NEC stage), the Str2D was lower compared with healthy individuals, suggesting the existence of subtle myocardial damage in these patients. Hypotheses that only time can confirm and track.

Introdução. A doença de Chagas é uma das principais causas de insuficiência cardíaca e sua identificação precoce pode ajudar a identificar pacientes com risco de progressão da doença. Strain longitudinal bidimensional (Str2D) poderia ser uma ferramenta útil para a detecção de disfunção ventricular esquerda incipiente. Objetivos. Analise se strain longitudinal dimensional pode detectar anormalidades em pacientes assintomáticos, sem patologia demonstrável por métodos convencionais na doença de Chagas. Materiais e métodos. Estudo transversal de 45 pacientes com idade inferior a 65 anos em uma área rural endêmica de doença de Chagas sem comprovada patologia (cardiopatia não evidente: CNE) versus 33 pacientes do grupo controle. Em todos os pacientes do estudo foi feita por dois métodos sorológicos, exame clínico, eletrocardiograma e ultrasom Doppler do coração: diâmetro diastólico do ventrículo esquerdo (DDVE), área do átrio esquerdo (AE), fração de ejeção do ventrículo esquerdo (Fey) por Simpson, excursão de anel tricúspide (TAPSE), relação E/A mitral (E/A), E/e' ratio, S tecido (S') do ventrículo esquerdo (VE) e do ventrículo direito (VD), Str2D de cada segmento VI e strain geral. Estatística: variáveis quantitativas de distribuição normal foram comparadas pelo teste t e qualitativa com o teste qui-quadrado. Variabilidade intra e interobservador para r Pearson e coeficiente de correlação intraclasse (CCI). Resultados. Idade, sexo e ecocardiograma Doppler convencional (DDVI, Fey, AE, TAPSE, E/A, E/e') não mostraram diferenças estatisticamente significativas. Strain global e strain dos segmentos do VE apicais apresentaram diferenças significativas entre os pacientes com doença de Chagas sem doença comprovada e seus controles; embora estes valores caem dentro da faixa considerada fisiológica. Variabilidade intra-observador da strain global (r de Pearson: 0,93 e CCI: 0,93) e inter-observador (coeficiente r de Pearson 0,89 e um CCI: 0,88). Conclusões. Os resultados deste estudo poderiam mostrar uma lesão miocárdica incipiente em pacientes com sorologia positiva para doença de Chagas sem cardiopatia demonstrada. A hipótese de trabalho de que só o tempo e um longo seguimento irão confirmar.

Social and Structural Challenges to Drug Cessation Among Couples in Northern Mexico: Implications for Drug Treatment in Underserved Communities.

BACKGROUND: Available drug treatment modalities may inadequately address social and structural contexts surrounding recovery efforts. METHODS: This mixed methods analysis drew on (1) surveys with female sex workers and their intimate male partners and (2) semi-structured interviews with a subsample of 41 couples (n=82 individuals, 123 total interviews) in Northern Mexico. Descriptive and content analyses examined drug cessation and treatment experiences. RESULTS: Perceived need for drug treatment was high, yet only 35% had ever accessed services. Financial and institutional barriers (childcare needs, sex-segregated facilities) prevented partners from enrolling in residential programs together or simultaneously, leading to self-treatment attempts. Outpatient methadone was experienced more positively, yet financial constraints limited access and treatment duration. Relapse was common, particularly when one partner enrolled alone while the other continued using drugs. CONCLUSIONS: Affordable, accessible, evidence-based drug treatment and recovery services that acknowledge social and structural contexts surrounding recovery are urgently needed for drug-involved couples.

Compulsive-like responding for opioid analgesics in rats with extended access.

The abuse of prescription opioids that are used for the treatment of chronic pain is a major public health concern, costing ∼$53.4 billion annually in lost wages, health-care costs, and criminal costs. Although opioids remain a first-line therapy for the treatment of severe chronic pain, practitioners remain cautious because of the potential for abuse and addiction. Opioids such as heroin are considered very rewarding and reinforcing, but direct and systematic comparisons of compulsive intake between commonly prescribed opioids and heroin in animal models have not yet been performed. In the present study, we evaluated the potential for compulsive-like drug seeking and taking, using intravenous self-administration of oxycodone, fentanyl, and buprenorphine in rats allowed long access sessions (12 h). We measured compulsive-like intake using an established escalation model and responding on a progressive ratio schedule of reinforcement. We compared the potential for compulsive-like self-administration of these prescription opioids and heroin, which has been previously established to induce increasing intake that models the transition to addiction in humans. We found that animals that self-administered oxycodone, fentanyl, or heroin, but not buprenorphine had similar profiles of escalation and increases in breakpoints. The use of extended access models of prescription opioid intake will help better understand the biological factors that underlie opioid dependence.

Client perspectives on design and implementation of a couples-based intervention to reduce sexual and drug risk behaviors among female sex workers and their noncommercial partners in Tijuana and Ciudad Juárez, México.

This mixed-methods study examined the acceptability of a hypothetical couples-based HIV prevention program for female sex workers and their intimate (non-commercial) male partners in Mexico. Among 320 participants, 67 % preferred couples-based over individual programs, particularly among men. Reasons cited for preferring couples-based programs included convenience and health benefits for both partners. Participants reported that they would benefit from general health information and services, HIV counseling and testing, job training (particularly for men) and other services. However, qualitative interviews revealed that barriers relating to the environment (i.e., poor access to services), providers (i.e., lack of a therapeutic alliance), and intimate relationships (i.e., mistrust or instability) would need to be addressed before such a program could be successfully implemented. Despite women's concerns about privacy and men's preferences for gender-specific services, couples-based HIV prevention programs were largely acceptable to female sex workers and their intimate male partners.