• Widespread Pain Is Associated with Increased Risk of No Clinical Improvement After TKA in Women

  Vina, Ernest R; Ran, Di; Ashbeck, Erin L; Kwoh, C Kent; Univ Arizona, Arthrit Ctr; Univ Arizona, Mel & Enid Zuckerman Coll Publ Hlth; Univ Arizona, Dept Epidemiol & Biostat; Univ Arizona, Dept Med, Div Rheumatol (LIPPINCOTT WILLIAMS & WILKINS, 2019-10-16)

  Background When conservative treatments do not work, TKA may be the best option for patients with knee osteoarthritis, although a relatively large proportion of individuals do not have clinically important improvement after TKA. Evidence also suggests that women are less likely to benefit from TKA than men, but the reasons are unclear. Widespread pain disproportionately affects women and has been associated with worse outcomes after joint arthroplasty, yet it is unknown if the effect of widespread pain on TKA outcomes differs by patient gender. Questions/purposes (1) Does the association between widespread pain and no clinically important improvement in osteoarthritis-related pain and disability 2 years after TKA differ between men and women? (2) Does the use of pain medications 2 years after TKA differ between those with widespread pain and those without widespread pain before surgery? Methods Osteoarthritis Initiative () study participants were followed annually from March 2005 until October 2015. Participants who underwent TKA up to the 7-year follow-up visit with pain/disability assessment at the protocol-planned visit before TKA and at the second planned annual visit after surgery were included in the analysis. Among 4796 study participants, 391 had a confirmed TKA, including 315 with pain/disability assessment at the protocol-planned visit before TKA. Overall, 95% of participants (298) had the required follow-up assessment; 5% (17) did not have follow-up data. Widespread pain was defined based on the modified American College of Rheumatology criteria. Symptoms were assessed using the WOMAC pain (range 0 to 20; higher score, more pain) and disability (range 0 to 68; higher score, more disability) scores, and the Knee Injury and Osteoarthritis Outcome Score for pain (range 0 to 100; higher score, less pain). Improvements in pain and disability were classified based on improvement from established clinically important differences (decrease in WOMAC pain >= 1.5; decrease in WOMAC disability >= 6.0; increase in Knee Injury and Osteoarthritis Outcome Score for pain >= 9). At baseline, more women presented with widespread pain than men (45% [84 of 184] versus 32% [36 of 114]). Probability and the relative risk (RR) of no clinically important improvement were estimated using a logistic regression analysis in which participants with widespread pain and those without were compared. The analyses were done for men and women separately, then adjusted for depression and baseline outcome scores. Results Among women, preoperative widespread pain was associated with an increased risk of no clinically important improvement 2 years after TKA, based on WOMAC pain scores (13.5% versus 4.6%; RR 2.93 [95% CI 1.18 to 7.30]; p = 0.02) and the Knee Injury and Osteoarthritis Outcome Score for pain (16.5% versus 4.9%; RR 3.39 [95% CI 1.34 to 8.59]; p = 0.02). Given the lower and upper limits of the confidence intervals, our data are compatible with a broad range of disparate associations between widespread pain and lack of clinically important improvement in WOMAC pain scores (RR 0.77 [95% CI 0.22 to 2.70]; p = 0.68) and the Knee Injury and Osteoarthritis Outcome Score for pain (RR 1.37 [95% CI 0.47 to 4.00]; p = 0.57) among men, as well as clinically important improvement in WOMAC disability scores among men (RR 0.72 [95% CI 0.20 to 2.55]; p = 0.61) and women (RR 1.98 [95% CI 0.92 to 4.26]; p = 0.08). Participants presenting with widespread pain before TKA were more likely than those without widespread pain to use medication for symptoms of knee osteoarthritis most days for at least 1 month 2 years after TKA (51% [61 of 120] versus 32% [57 of 178]; mean difference, 18.8 [95% CI 7.3 to 30.1]; p < 0.01). Conclusions Widespread pain before TKA was associated with an increased risk of no clinically important improvement in knee pain 2 years postoperatively among women. Because of the small number of men with widespread pain in the sample, the results for men were inconclusive. In clinical practice, screening TKA candidates for widespread pain may be useful, and expectations of surgical outcomes may need to be tempered if patients have a concurrent diagnosis of widespread pain. Future studies should include more men with widespread pain and investigate if treatment of widespread pain before or concurrent with TKA surgery may improve surgical outcomes.
• Pharmacological DNA Demethylation Weakens Inhibitory Synapses in the Auditory Cortex and Re-opens the Critical Period for Frequency Map Plasticity

  Schwartz, Benjamin A; Wang, Weihua; Bao, Shaowen; Univ Arizona, Neurosci Program (PERGAMON-ELSEVIER SCIENCE LTD, 2020-06-06)

  The critical period is a time of maximal plasticity within the cortex. The progression of the critical period is marked by experience-dependent transcriptional alterations in cortical neurons, which in turn shifts the excitatory-inhibitory balance in the brain, and accordingly reduces plasticity. Epigenetic mechanisms, such as DNA methylation, control the transcriptional state of neurons, and have been shown to be dynamically regulated during the critical period. Here we show that adult animals have a significantly higher concentration of DNA methylation than critical period animals. Pharmacological reduction of DNA methylation in adult animals re-establishes critical period auditory map plasticity. Furthermore, the reduction of DNA methylation in adult animals, reverted intrinsic characteristics of inhibitory synapses to an immature state. Our data suggest that accumulation of DNA methylation during the critical period confers a mature phenotype to cortical neurons, which in turn, facilitates the reduction in plasticity seen after the critical period. (c) 2020 IBRO. Published by Elsevier Ltd. All rights reserved.
• 

  Frequency of hand-to-head, -mouth, -eyes, and -nose contacts for adults and children during eating and non-eating macro-activities

  Wilson, Amanda M; Verhougstraete, Marc P; Beamer, Paloma I; King, Marco-Felipe; Reynolds, Kelly A; Gerba, Charles P; Univ Arizona, Coll Agr & Life Sci, Dept Environm Sci; Univ Arizona, Mel & Enid Zuckerman Coll Publ Hlth, Dept Commun Environm & Policy (NATURE PUBLISHING GROUP, 2020-07-15)

  Hand-to-face contacts are important for estimating chemical and microbial exposures. Few studies describe children's hand-to-eye or -nose contacts or adults' hand-to-face contacts. The study objective was to characterize hand-to-head (mouth, eyes, nose, and other) contacts for children in a daycare and adults in multiple locations. Macro-activities and sequences of hand-to-face contacts were recorded for 263 people observed for 30 min each. Statistically significant differences between locations, males and females, adults and children, and during eating and non-eating macro-activities were evaluated. Discrete Markov chains were fit to observed contact sequences and compared among adults and children during eating and non-eating macro-activities. No significant differences in contact frequency were observed between males and females with the exception of hand-to-nose contacts. Children tended to touch the mouth, eyes, and nose more frequently than adults during non-eating macro-activities. Significant differences in contact frequency were observed between locations. Transitional probabilities indicated that children make repetitive mouth, eye, and nose contacts while adults frequently transition to contacts of the head other than the mouth, eyes, or nose. More data are needed to evaluate the effect of age on adults' contact frequencies and to confirm lack of statistically significant differences between adults and children during eating macro-activities.
• Brownian fluctuations of flame fronts with small random advection

  Henderson, Christopher; Souganidis, Panagiotis E.; Univ Arizona, Dept Math (WORLD SCIENTIFIC PUBL CO PTE LTD, 2020-06-10)

  We study the effect of small random advection in two models in turbulent combustion. Assuming that. the velocity field decorrelates sufficiently fast, we (i) identify the order of the fluctuations of the front with respect to the size of the advection; and (ii) characterize them by the solution of a Hamilton-Jacobi equation forced by white noise. In the simplest case, the result yields, for both models, a front with Brownian fluctuations of the same scale as the size of the advection. That the fluctuations are the same for both models is somewhat. surprising, in view of known differences between the two models.
• Correlates of cognitive impairment in adult cancer survivors who have received chemotherapy and report cognitive problems

  Gutenkunst, Shannon L; Vardy, Janette L; Dhillon, Haryana M; Bell, Melanie L; Univ Arizona, Stat Grad Interdisciplinary Program; Univ Arizona, Mel & Enid Zuckerman Coll Publ Hlth, Dept Epidemiol & Biostat (SPRINGER, 2020-07-14)

  Objective Cognitive impairment negatively affects some cancer survivors who have completed chemotherapy; however, factors underlying this cognitive impairment remain poorly understood. We aimed to investigate (1) the relative importance of demographics, medical, and psychological characteristics associated with cognitive impairment and (2) the specific variables associated with cognitive impairment in adult cancer survivors who completed adjuvant chemotherapy. Methods We performed post hoc analyses of baseline data from early-stage cancer survivors with cognitive complaints who received adjuvant chemotherapy 0.5-5 years earlier and volunteered for a trial designed to improve cognition. The primary outcome of self-reported cognitive impairment was measured using a questionnaire; secondary outcome of objective cognitive impairment was measured using a computerized neuropsychological test battery. Hierarchical linear regression determined the relative importance of demographics, medical, and psychological characteristics in associations with both self-reported and objective cognitive impairment. Results The sample was 95% female and 89% breast cancer patients. The final model accounted for 33% of variation in self-reported cognitive impairment (n = 212, demographics 5%, medical 3%, and psychological 25%), with fatigue and stress as significant individual correlates (pvalues <= 0.0001). For the secondary analysis, the final model accounted for 19% of variation in objective cognitive impairment (n = 206, demographics 10%, medical 5%, and psychological 4%), with age, smoking history, and number of chemotherapy cycles as significant individual correlates. Conclusion We found that psychological characteristics are more important than demographic and medical characteristics in self-reported cognitive impairment, whereas other characteristics are more important in objective cognitive impairment. This suggests clinicians should investigate possible psychological problems in cancer survivors who self-report cognitive impairment.

View more