Advances in Pain Medicine: a Review of New Technologies.

PURPOSE OF REVIEW: This narrative review highlights the interventional musculoskeletal techniques that have evolved in recent years. RECENT FINDINGS: The recent progress in pain medicine technologies presented here represents the ideal treatment of the pain patient which is to provide personalized care. Advances in pain physiology research and pain management technologies support each other concurrently. As new technologies give rise to new perspectives and understanding of pain, new research inspires the development of new technologies.

MASK MANDATES REDUCE COVID-19 MORTALITY: Analysis of 37 States and the District of Columbia, with a further analysis of the impact of demographic and medical factors on efficacy.

As the number of COVID-19 deaths in the US increased, various policies were enacted to slow the spread of the pandemic. While the situation has improved in recent months, determining how best to combat the current pandemic is still essential. Failure to do so invites both further resurgences of the current pandemic, and more pandemics in the years to come. As a result of the widespread failure to contain the spread of COVID-19, enough deaths have occurred that the impact of policy on mortality may be statistically evaluated. This paper uses Optimal Discriminant Analysis (ODA) to evaluate the hypothesized ability of limited mask mandates (MM) to reduce the daily number of COVID-19 deaths in the states analyzed. The mandates were found to reduce mortality in half the states analyzed and did not result in increased mortality in any states. A full range of cofactors were analyzed to determine which, if any, influenced the efficacy of the mandates in the states in which mandates had an effect. Institutional Health Subindex of the Social Capital Index, state health score, population density, portion of the population with nongroup health insurance, state GDP, and the rate of pregnancy related diabetes were all correlated with increased mandate efficacy. In contrast, incarceration rate, overcrowded housing, severely overcrowded housing, portion of the population with military provided insurance, portion of the population uninsured, the portion of the population unable to see a doctor due to cost, and the portion of the population who were American Indian/Native Alaskan were all correlated with reduced mandate efficacy.

Mask mandates can limit COVID spread: Quantitative assessment of month-over-month effectiveness of governmental policies in reducing the number of new COVID-19 cases in 37 US States and the District of Columbia

IntroductionSARS-CoV-2 is the beta-coronavirus responsible for COVID-19. Facemask use has been qualitatively associated with reduced COVID-19 cases, but no study has quantitatively assessed the impact of government mask mandates (MM) on new COVID-19 cases across multiple US States. Data and MethodsWe utilized a non-parametric machine-learning algorithm to test the a priori hypothesis that MM were associated with reductions in new COVID-19 cases. Publicly available data were used to analyze new COVID-19 cases from 37 States and the District of Columbia (i.e., "38 States"). We conducted confirmatory All-States and State-Wise analyses, validity analyses [e.g., leave-one-out (LOO) and bootstrap resampling], and covariate analyses. ResultsNo statistically significant difference in the daily number of new COVID-19 infections was discernable in the All-States analysis. In State-Wise LOO validity analysis, 11 States exhibited reductions in new COVID-19 and the reductions in four of these States (AK, MA, MN, VA) were significant in bootstrap resampling. Only the Social Capital Index predicted MM success (training p<0.028 and LOO p<0.013). ConclusionResults obtained when studying the impact of MM on COVID-19 cases varies as a function of the heterogeneity of the sample being considered, providing clear evidence of Simpsons Paradox and thus of confounded findings. As such, studies of MM effectiveness should be conducted on disaggregated data. Since transmissions occur at the individual rather than at the collective level, additional work is needed to identify optimal social, psychological, environmental, and educational factors which will reduce the spread of SARS-CoV-2 and facilitate MM effectiveness across diverse settings.

Comparative policy analysis of face mask mandates during COVID 19 pandemic on rate of mask use in the United States

As COVID-19 continues to spread throughout the United States, there has been a search for policies to prevent individual infections, to slow the spread of the virus in general, and to mitigate the economic impact of the pandemic. Masks have proven to be a cost-effective measure in all regards, and as such some state governments have begun to mandate their use. However, while the efficacy of masks has been demonstrated, the efficacy of public policies which mandate the use of masks has not been demonstrated. This paper compares the rates of mask use in counties as defined by state policy. It finds that state mandates are strongly correlated with higher rates of mask use, and that mandating use by all individuals in public spaces is more effective than a less comprehensive mandate for mask use by all public facing employees.

Preventive and Mitigative Effects of Alendronate on Osteolysis induced by Particulate Debris: Quantitative and Comparative Analysis Using Mouse Calvarial Model / 대한정형외과학회잡지

PURPOSE: Wear particle induced osteolysis is a serious complication in total joint arthroplasty. The purpose of this study was to compare the preventive and mitigative effects of alendronate on particle induced osteolysis among particles using mouse calvarial model. MATERIALS AND METHODS: Seventy-two mice were randomized into sham group, Ti6Al4V group, CoCr- Mo group and Ultra High Molecular Weight Polyethylene (UHMWPE) group according to the particles treated to the calvarial tissues. Each group was divided into control subgroup which received no alendronate, preventive subgroup which received alendronate for 4 weeks after particle distribution and therapeutic subgroup which received alendronate for 3 weeks after 1 week delay from particle distribution. We evaluated the effects quantitatively using histomorphometry. Number of osteoclast, fibrous thickness, eroded bone surface area, bone thickness and bone volume were measured and compared. RESULTS: Alendronate showed significant preventive and mitigative effects on osteolysis induced by Ti6Al4V particles and showed significant preventive and somewhat less mitigative effect on osteolysis by CoCrMo particles. On UHMWPE particles, alendronate showed no preventive and mitigative effects. CONCLUSION: Alendronate may be useful in preventing osteolysis induced by metal particles but had no effect on ostelysis induced by UHMWPE particles.

Expression of RANKL/OPG in Joint Fluids of Periprosthetic Osteolysis / 대한정형외과학회잡지

PURPOSE: This study evaluated the expression level of Receptor Activator of NF-kappaB Ligand (RANKL), Osteoprotegerin (OPG)and other pro-inflammatory cytokines in the osteoarthritic and periprosthetic joint fluid in order to characterize the role of these regulatory proteins in periprosthetic osteolysis. MATERIALS AND METHODS: Joint fluid specimens taken from 47 patients undergoing hip or knee reconstructive surgery were analyzed by enzyme-linked immunoassay (ELISA)in order to determine the relative protein expression level of RANKL, OPG, IL-1beta, IL-6 and TNF-alpha. The fluid from joints with osteoarthritis (15 cases, Group I), implants revised without associated osteolysis (15 cases, Group II)and failed implants with radiographically moderate to severe osteolysis (17 cases, Group III) were compared. The fluids from all cases with implants (Group II and III) was combined (Group IV)and compared with the osteoarthritic joint fluids. RESULTS: RANKL was present in all the fluids at similar concentrations. The OPG levels were significantly lower (2.2-3.9 fold)in Groups II and III than in Group I (p<0.0001). The IL-1beta concentration was significantly higher in Groups II, III and IV and with Group III being the highest (12.1 fold)(p<0.0001). The IL-6 expression level was significantly higher in Group III (2.0 fold)than in Groups I and II (p<0.0001). The TNF-alpha levels were 2.0 times higher in Group III and significantly higher in all implant cases (Group IV)are analyzed (p=0.03). CONCLUSION: Permissive RANKL protein expression coupled with suppressed OPG levels and enhanced osteoclastogenic cytokine expression results in periprosthetic osteolysis.