An Educational and Exercise Mobile Phone-Based Intervention to Elicit Electrophysiological Changes and to Improve Psychological Functioning in Adults With Nonspecific Chronic Low Back Pain (BackFit App): Nonrandomized Clinical Trial.

BACKGROUND: Concomitant psychological and cognitive impairments modulate nociceptive processing and contribute to chronic low back pain (CLBP) maintenance, poorly correlated with radiological findings. Clinical practice guidelines recommend self-management and multidisciplinary educational and exercise-based interventions. However, these recommendations are based on self-reported measurements, which lack evidence of related electrophysiological changes. Furthermore, current mobile health (mHealth) tools for self-management are of low quality and scarce evidence. Thus, it is necessary to increase knowledge on mHealth and electrophysiological changes elicited by current evidence-based interventions. OBJECTIVE: The aim of this study is to investigate changes elicited by a self-managed educational and exercise-based 4-week mHealth intervention (BackFit app) in electroencephalographic and electrocardiographic activity, pressure pain thresholds (PPTs), pain, disability, and psychological and cognitive functioning in CLBP versus the same intervention in a face-to-face modality. METHODS: A 2-arm parallel nonrandomized clinical trial was conducted at the University of the Balearic Islands (Palma, Spain). A total of 50 patients with nonspecific CLBP were assigned to a self-managed group (23/50, 46%; mean age 45.00, SD 9.13 years; 10/23, 43% men) or a face-to-face group (27/50, 54%; mean age 48.63, SD 7.54 years; 7/27, 26% men). The primary outcomes were electroencephalographic activity (at rest and during a modified version of the Eriksen flanker task) and heart rate variability (at rest), PPTs, and pressure pain intensity ratings. The secondary outcomes were pain, disability, psychological functioning (mood, anxiety, kinesiophobia, pain catastrophizing, and fear-avoidance beliefs), and cognitive performance (percentage of hits and reaction times). RESULTS: After the intervention, frequency analysis of electroencephalographic resting-state data showed increased beta-2 (16-23 Hz; 0.0020 vs 0.0024; P=.02) and beta-3 (23-30 Hz; 0.0013 vs 0.0018; P=.03) activity. In addition, source analyses revealed higher power density of beta (16-30 Hz) at the anterior cingulate cortex and alpha (8-12 Hz) at the postcentral gyrus and lower power density of delta (2-4 Hz) at the cuneus and precuneus. Both groups also improved depression (7.74 vs 5.15; P=.01), kinesiophobia (22.91 vs 20.87; P=.002), activity avoidance (14.49 vs 12.86; P<.001), helplessness (6.38 vs 4.74; P=.02), fear-avoidance beliefs (35 vs 29.11; P=.03), and avoidance of physical activity (12.07 vs 9.28; P=.01) scores, but there was an increase in the disability score (6.08 vs 7.5; P=.01). No significant differences between the groups or sessions were found in heart rate variability resting-state data, electroencephalographic data from the Eriksen flanker task, PPTs, subjective ratings, or cognitive performance. CONCLUSIONS: Both intervention modalities increased mainly beta activity at rest and improved psychological functioning. Given the limitations of our study, conclusions must be drawn carefully and further research will be needed. Nevertheless, to the best of our knowledge, this is the first study reporting electroencephalographic changes in patients with CLBP after an mHealth intervention. TRIAL REGISTRATION: ClinicalTrials.gov NCT04576611; https://clinicaltrials.gov/ct2/show/NCT04576611.

Meningioma of the scapula.

Meningiomas account for approximately 15% of all intracranial tumors and are the most common non-glial primary tumors of the central nervous system. Most meningiomas are benign neoplasms with characteristic imaging features. Primary extradural meningiomas account for only 1-2% of all meningiomas. They must be differentiated from intradural meningiomas with secondary extradural extension and/or metastases. The vast majority of extradural meningiomas are found in the skull or in the head and neck region. We report on an extremely rare case of primary extradural meningioma that was located in the scapula. The lesion was resected. Radiographic findings and pathologic features are discussed. To the best of our knowledge, this form of presentation of an extradural meningioma has not been previously described.

Focal myositis of the thigh: unusual MR pattern.

Focal myositis is a commonly referenced, infrequently reported and poorly documented benign inflammatory pseudotumor which may be misdiagnosed clinically as a malignant tumor. We report the clinicopathologic features and magnetic resonance imaging findings in a case of focal myositis in the thigh of a 55-year-old woman. A different radiologic presentation of this disorder is described. The gross appearance of the lesion, previously undescribed, appears to be rather specific for such a pseudoneoplastic disorder, and correlates very well with the magnetic resonance imaging features.

Estudio comparativo entre métodos ecocardiográficos y de resonancia magnética en el cálculo de la masa ventricular izquierda / Echocardiography and Magnetic Resonance Imaging in the Assessment of Left Ventricular Mass: a Comparative Study

Introducción y objetivos. La ecocardiografía es el método más utilizado para el cálculo de la masa ventricular izquierda, aunque la resonancia magnética se considera actualmente la técnica de referencia. El presente estudio compara la ecocardiografía en modo M con la resonancia magnética, estudiándose además la utilidad de un método simplificado de cálculo por resonancia magnética. Métodos. En 42 pacientes se determinó la masa ventricular izquierda por ecocardiografía en modo M, por las fórmulas denominadas de Penn y de la Sociedad Americana de Ecocardiografía, así como por resonancia magnética, aplicando un método anatómico (sumación de cortes transversales múltiples ventriculares), considerado de referencia, y un método geométrico (planimetría de un corte simple longitudinal). Resultados. La ecocardiografía resultó técnicamente inadecuada para el cálculo en 3/42 pacientes (7 por ciento), mientras que por resonancia fue posible en todos los casos. La correlación entre los métodos ecocardiográficos y el método anatómico de resonancia presentó coeficientes r = 0,70 (método de Penn) y r = 0,71 (Sociedad Americana de Ecocardiografía), con una sobrestimación sistemática del valor de la masa, particularmente con el método de Penn. Asimismo, el método geométrico de resonancia ofreció una excelente correlación con el método anatómico (r = 0,93). Conclusiones. La aplicabilidad de la resonancia para el cálculo de la masa ventricular izquierda es superior a la de la ecocardiografía en modo M, cuyos valores sobrestiman las determinaciones de la primera, particularmente con el método de Penn. El método simplificado de cálculo geométrico de la masa por resonancia magnética constituye una alternativa válida al método anatómico (AU)