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Purpose: Studies have reported inverse associations of pre-diagnosis recreational physical activity (RPA) level with all-cause and breast cancer (BCa)-specific mortality among BCa patients. However, the association between pre-diagnosis RPA level and BCa recurrence is unclear. We investigated the association between pre-diagnosis RPA level and risk of BCa recurrence in the California Teachers Study (CTS). Methods: Stage I–IIIb BCa survivors (n = 6,479) were followed with median of 7.4 years, and 474 BCa recurrence cases were identified. Long-term (from high school to age at baseline questionnaire, or, age 55 years, whichever was younger) and baseline (past 3 years reported at baseline questionnaire) pre-diagnosis RPA levels were converted to metabolic equivalent of task-hours per week (MET-hrs/wk). Multivariable Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for risk of BCa recurrence overall and by estrogen receptor (ER)/progesterone receptor (PR) status. Results: Long-term RPA was not associated with BCa recurrence risk (ptrend = 0.99). The inverse association between baseline pre-diagnosis RPA level and BCa recurrence risk was marginally significant (≥26.0 vs. <3.4 MET-hrs/wk: HR = 0.79, 95% CI = 0.60–1.03; ptrend = 0.07). However, the association became non-significant after adjusting for post-diagnosis RPA (ptrend = 0.65). An inverse association between baseline pre-diagnosis RPA level and BCa recurrence risk was observed in ER−PR− cases (≥26.0 vs. <3.4 MET-hrs/wk: HR = 0.31, 95% CI = 0.13–0.72; ptrend = 0.04), but not in ER+ or PR+ cases (ptrend = 0.97). Conclusions: Our data indicates that the benefit of baseline RPA on BCa recurrence may differ by tumor characteristics. This information may be particularly important for populations at higher risk of ER−PR− BCa. [ABSTRACT FROM AUTHOR]

A liquid sampling-atmospheric pressure glow discharge (LS-APGD) ionization source operating at a nominal power of 30 W and solution flow rate of 30 µL min−1 and supported in a He sheath gas flow rate of 500 mL min−1 was interfaced to an Orbitrap mass spectrometer and assessed for use in rapid identification of inorganic and organic arsenic species, including As(III), As(V), monomethylarsonic acid, dimethylarsinic acid, and arsenobetaine in a 2% (v/v) nitric acid medium. Mass spectral acquisition in low-resolution mode, using only the ion trap analyzer, provided detection of protonated molecular ions for AsBet (m/z 179), DMA (m/z 139), MMA (m/z 141), and As(V) (m/z 143). As(III) is oxidized to As(V), likely due to in-source processes. Typical fragmentation of these compounds resulted in the loss of either water or methyl groups, as appropriate, i.e., introducing DMA also generated ions corresponding to MMA and As(V) as dissociation products. Structure assignments were also confirmed by high-resolution Orbitrap measurements. Spectral fingerprint assignments were based on the introduction of solutions containing 5 µg mL−1 of each arsenic compound. [ABSTRACT FROM AUTHOR]

Purpose: Higher pre-diagnosis physical activity (PA) is associated with lower all-cause mortality in breast cancer (BCa) patients. However, the association with pathological complete response (pCR) is unclear. We investigated the association between pre-diagnosis PA level and chemotherapy completion, dose delay, and pCR in BCa patients receiving neoadjuvant chemotherapy (NACT). Methods: 180 stage I–III BCa patients receiving NACT (mean [SD] age of diagnosis: 60.8 [8.8] years) in the Sister Study were included. Self-reported recreational and total PA levels were converted to metabolic equivalent of task-hours per week (MET-hrs/wk). The pCR was defined as no invasive or in situ residual in breast or lymph node (ypT0 ypN0). Multivariable logistic regression analyses estimated odds ratios (ORs) and 95% confidence intervals (CIs) for treatment outcomes. Results: In this sample, 45 (25.0%) BCa patients achieved pCR. Higher pre-diagnosis recreational PA was not associated with lower likelihood of chemotherapy completion (highest vs. lowest tertile: OR = 0.87, 95% CI = 0.30–2.56; Ptrend = 0.84), greater dose delay (OR = 1.45, 95% CI = 0.54–3.92; Ptrend = 0.46), or greater odds of pCR (OR = 1.28, 95% CI = 0.49–3.34; Ptrend = 0.44). Associations were similar for pre-diagnosis total PA. Meeting the recommended level of recreational PA was not associated with pCR overall (≥ 7.5 vs. < 7.5 MET-hrs/wk: OR = 1.33, 95% CI = 0.59–3.01). Conclusions: Although small sample size and limited information on exercise closer to time of diagnosis limit interpretation, pre-diagnosis PA was not convincingly associated with treatment tolerance or treatment efficacy in BCa patients receiving NACT. Future investigations are needed to better understand the impact of pre-diagnosis PA on BCa treatment. [ABSTRACT FROM AUTHOR]

Endocrine therapy (ET) for breast cancer treatment is associated with cognitive complaints, but their etiology is poorly understood. To address this, we developed and implemented an ambulatory assessment protocol consisting of wearable activity monitors, brief surveys of affect, context, and perceived impairments, and ultra-brief performance-based measures of cognition. Newly diagnosed, ER/PR+, stage 0-III, female breast cancer patients, were recruited. Ambulatory assessments were conducted on smart phones and wearable activity monitors were used to monitor sleep and physical activity. Participants were asked to complete five 7-day measurement bursts (one before starting ET and one each month for 4 consecutive months while on ET). We observed a consent rate of 36%, 27 women completed the study. Of the women that withdrew, 91% dropped prior to the midpoint of follow up. There were no significant differences in demographics, clinical breast cancer characteristics, sleep or physical activity patterns, or measures of cognition between women who completed versus withdrew. Women who did not complete the study provided fewer valid days of baseline data. In conclusion, while some women may be overwhelmed with their cancer diagnosis, we did not identify any predictive characteristics of women whom did not complete the study. This novel method enables the prospective study of psychological changes associated with cancer treatment, capturing a wide array of information about behavior, experience, and cognition, thus providing a picture of the lived experiences of cancer patients before and during exposure to ET. [ABSTRACT FROM AUTHOR]

Purpose of Review: A wellspring of new research has offered varying models of resilience in chronic pain populations; however, resilience is a multifaceted and occasionally nebulous construct. The current review explores definitional and methodological issues in existing observational and clinical studies and offers new directions for future studies of pain resilience. Recent Findings: Definitions of pain resilience have historically relied heavily upon self-report and from relatively narrow scientific domains (e.g., positive psychology) and in narrow demographic groups (i.e., Caucasian, affluent, or highly educated adults). Meta-analytic and systematic reviews have noted moderate overall quality of resilience-focused assessment and treatment in chronic pain, which may be attributable to these narrow definitions. Summary: Integration of research from affiliated fields (developmental models, neuroimaging, research on historically underrepresented groups, trauma psychology) has the potential to enrich current models of pain resilience and ultimately improve the empirical and clinical utility of resilience models in chronic pain. [ABSTRACT FROM AUTHOR]

Exercise oncology clinical trials contribute to the advancement of our scientific knowledge and to the safety and care of patients diagnosed with cancer. Nevertheless, regulatory reviewers and committees may not be familiar with the well-documented long-term health benefits and safety of the regular practice of physical activity. Moreover, they may not see how the benefits outweigh the risks in the context where patients diagnosed with cancer are typically seen as vulnerable. Therefore, we would like to provide a purpose-built overview of exercise oncology clinical trials for members involved in institutional review committees, including the Scientific Review Committee (SRC), the Institutional Review Board (IRB), and the Data Safety Monitoring Committee (DSMC) to facilitate a greater understanding of the safety and benefits of physical activity during cancer treatments. Communication is key to improve the success of exercise oncology clinical trials, which are vital for patients diagnosed with cancer. [ABSTRACT FROM AUTHOR]

Background: The use of medical 3D printing (focusing on anatomical modeling) has continued to grow since the Radiological Society of North America's (RSNA) 3D Printing Special Interest Group (3DPSIG) released its initial guideline and appropriateness rating document in 2018. The 3DPSIG formed a focused writing group to provide updated appropriateness ratings for 3D printing anatomical models across a variety of congenital heart disease. Evidence-based- (where available) and expert-consensus-driven appropriateness ratings are provided for twenty-eight congenital heart lesion categories. Methods: A structured literature search was conducted to identify all relevant articles using 3D printing technology associated with pediatric congenital heart disease indications. Each study was vetted by the authors and strength of evidence was assessed according to published appropriateness ratings. Results: Evidence-based recommendations for when 3D printing is appropriate are provided for pediatric congenital heart lesions. Recommendations are provided in accordance with strength of evidence of publications corresponding to each cardiac clinical scenario combined with expert opinion from members of the 3DPSIG. Conclusions: This consensus appropriateness ratings document, created by the members of the RSNA 3DPSIG, provides a reference for clinical standards of 3D printing for pediatric congenital heart disease clinical scenarios. [ABSTRACT FROM AUTHOR]

Context: An exciting research frontier is the intersection of wildlife ecology and social science. Associated research is embracing a spatial approach to integrating ecological and social data to investigate the complex relationships between wildlife and humans across landscapes. However, there is a lack of coherence on the status, current methodology, and potential future directions of this body of research to advance landscape analyses. Objectives: We provided a review of the current state of the science of social-ecological research and modeling of human-wildlife interactions across space, with a goal of compiling state-of-the-art approaches, methods, major findings, limitations, and future directions. Methods: We performed a systematic literature review of peer-reviewed journal articles published from January 2000 to August 2023. We synthesized methods, lessons learned, and key themes in the literature. Results: Synthesized findings pointed to the importance of spatial context in shaping wildlife and human attributes and their interactions, and the demonstrated value of adding social science data to contest past practices of oversimplifying the complex drivers of human-wildlife interactions. Challenges and limitations included spatial scale mismatches, the limits of assigning causality, misaligned terminology, and need for more in-depth and diverse social science data collection methods and frameworks. Conclusions: These studies highlighted the potential for social-ecological analyses to inform management through identification of key levers, scenario modeling, and avoidance of "panacea traps." Our results also chart a path forward that calls for more extensive data integration, investigation of feedbacks, and multi-scale approaches to more deeply understand human-wildlife relationships across landscapes. [ABSTRACT FROM AUTHOR]

We used data from 444 undergraduates and 375 adults recruited online to evaluate lay raters' perceptions of vignettes described as having high levels of narcissistic traits. Participants were presented with vignettes describing someone with grandiose narcissistic characteristics only (e.g., someone who is arrogant), followed by vignettes describing someone with both grandiose and vulnerable narcissistic features (e.g., feeling insecure). Our primary aims focused on determining the extent to which (a) lay raters viewed narcissistic grandiosity and vulnerability as interconnected and (b) how attitudes toward vignettes varied as a function of the vulnerable and grandiose characteristics in the vignette descriptions. We also examined associations between lay raters' self-rated personality (assessed using the Narcissistic Admiration and Rivalry Questionnaire and the Big Five Inventory-2) and their vignette perceptions. Lay raters rated the vignette described as having only grandiose features as being prone to experiencing vulnerability. Furthermore, lay raters had more favorable views of the vignette including descriptions of both grandiose and vulnerable features (versus grandiose features alone). Likability and sympathy ratings did not vary based on the name used for vignettes (i.e., using the name "James" versus "Mary"). Finally, lay raters' self-rated traits showed some interesting associations with their vignette perceptions, but generally associations were weak in magnitude. Collectively, our findings indicate that lay raters perceive grandiosity and vulnerability as overlapping, and co-occurring grandiosity and vulnerability (versus grandiosity alone) may represent a more sympathetic view of narcissism. Determining the extent to which these attitudes influence real-world interactions would be useful for extending our findings. [ABSTRACT FROM AUTHOR]

Background: Chronic levels of inflammation are associated with higher risk of many chronic diseases. Physical activity (PA) lowers the risk of cancer, cardiovascular disease (CVD), diabetes and others. One mechanism for PA-induced protection may be through the immune system. We investigated the association between leisure-time PA and peripheral immune cell populations in a large nationally representative sample of the US general population. Methods: A total of 17,093 participants [mean (SE) age of 41.6 (0.3) years] of the National Health and Nutrition Examination Survey 1999–2018 were included. Self-reported leisure-time PA was converted to metabolic equivalent of task hours per week (MET-hrs/wk). White blood cell (WBC) count, WBC ratios, and platelet count were derived. Multivariable linear regression analyses were used to estimate associations between leisure-time PA level and peripheral immune cell populations. Multivariable logistic regression analyses were used to estimate associations between leisure-time PA and metrics of WBC count and neutrophil-to-lymphocyte ratio (NLR) which may predict mortality. Results: A higher leisure-time PA level was associated with a lower WBC count (> 14.0 vs. < 1.2 MET-hrs/wk adjusted mean (95% confidence interval [CI]): 7.12 (6.86, 7.38) vs. 7.38 (7.12, 7.64) 1000 cells/μL, Ptrend < 0.001) and a lower NLR (> 14.0 vs. < 1.2 MET-hrs/wk adjusted mean (95% CI) 2.04 (1.90, 2.18) vs. 2.13 (1.99, 2.28), Ptrend = 0.007). Leisure-time PA level was not associated with lymphocyte-to-monocyte ratio (LMR; Ptrend = 0.25) or platelet-to-lymphocyte ratio (PLR; Ptrend = 0.69). Compared to the lowest leisure-time PA level (< 1.2 MET-hrs/wk), the highest leisure-time PA level (≥ 14.0 MET-hrs/wk) was associated with a lower probability of a high WBC count (> 8.1 × 109 cells/L; odds ratio [OR] = 0.76, 95% CI = 0.66–0.88) and high NLR (> 2.68; OR = 0.84, 95% CI = 0.72–0.99), which may predict CVD and all-cause mortality. The highest leisure-time PA level also linked to a lower probability of a high WBC count (≥ 8.3 × 109 cells/L; OR = 0.76, 95% CI = 0.66–0.88), which may predict cancer mortality. Conclusions: We observed an inverse association between leisure-time PA level, WBC count, and NLR, particularly for neutrophil levels. These results suggest that participants at higher levels of leisure-time PA may have lower levels of inflammation, which may be important for future chronic disease outcomes. Key Points: In this cross-sectional analysis of 17,093 participants, a higher leisure-time physical activity level was associated with a lower white blood cell (WBC) count and a lower neutrophil-to-lymphocyte ratio (NLR). In gender-specific analysis, the inverse association between leisure-time physical activity level and WBC count was consistent in both genders, while the inverse relationship with NLR was observed in women exclusively. Participants at higher levels of leisure-time physical activity may have lower levels of inflammation, which may be important for future chronic disease outcomes. [ABSTRACT FROM AUTHOR]

Background/Objectives: Malnutrition underlies 45% of deaths in children under-5 years annually. Children hospitalised with complicated severe acute malnutrition (SAM) have unacceptably high mortality. We aimed to identify variables from early hospital admission (baseline factors) independently associated with inpatient mortality in this cohort to identify those most at risk. Subjects/Methods: Observational study of 745 children aged 0–59 months admitted with complicated SAM at three hospitals in Zimbabwe/Zambia. Children underwent anthropometry and clinical assessment by a study physician within 72 h of enrolment, and caregivers provided sociodemographic data. Children were followed-up daily until discharge/death. A multivariable survival analysis identified the baseline factors independently associated with mortality. Results: 70/745 (9.4%) children died in hospital. Age between 6–23 months [aHR 6.53, 95%CI 2.24–19.02], higher mid-upper arm circumference [aHR 0.73, 95%CI 0.59–0.89], presence of oedema [aHR 2.22, 95%CI 1.23–4.05], shock [aHR 8.18, 95%CI 3.79–17.65], sepsis [aHR 3.13, 95%CI 1.44–6.80], persistent diarrhoea [aHR 2.27, 95%CI 1.18–4.37], lack of a toilet at home [aHR 4.35, 95%CI 1.65–11.47], and recruitment at one Harare site [aHR 0.38, 95%CI 0.18–0.83] were all independently associated with inpatient mortality. Oedematous children had a significantly higher birthweight [2987 g vs 2757 g, p < 0.001] than those without oedema; higher birthweight was weakly associated with mortality [aHR 1.50 95%CI 0.97–2.31]. Conclusions: Children with oedema, low MUAC, baseline infections, shock and lack of home sanitation had a significantly increased risk of inpatient mortality following hospitalisation for complicated SAM. Children with high-risk features may require additional care. A better understanding of the pathophysiology of SAM is needed to identify adjunctive interventions. [ABSTRACT FROM AUTHOR]

Viewing physical pain as one of the consequences of racism and societal injustice more broadly illuminates these effects and points towards effective solutions for those afflicted with chronic pain as well as offering the potential for a more just and inclusive society. However, more innovative psychological approaches,[32],[59],[60] such as emotional awareness and expression therapy[32],[60] and pain reprocessing therapy,[61] specifically target psychosocial trauma or factors that activate the pain danger alarm, and show promise for greater pain reduction. THE BRAIN AS A KEY SOURCE OF CHRONIC PAIN Recent advances in theory and research highlight the fundamental role of the brain in the development and maintenance of chronic pain.[18],[19] In contrast to the traditional medical conceptualization, tissue pathology is not required for the experience of pain. With ongoing threats of either a somatic or psychosocial nature, pain can become chronic.[28],[29],[32] Is such brain-based or "centrally-mediated" pain a "false" pain experience?. [Extracted from the article]

Purpose: Cancer and its treatments accelerate biological aging. This analysis tested the hypothesis that exercise and diet reduce oxidative stress and prevent telomere shortening in breast cancer survivors. Methods: In a 2 × 2 factorial design, 342 breast cancer survivors who were insufficiently physically active and had overweight or obesity at enrollment were randomized to one of four treatment groups for 52 weeks: control, exercise alone, diet alone, or exercise plus diet. The endpoints of this analysis were the change from baseline to week 52 in 8-iso-prostaglandin F2α (8-iso-PGF2α) and lymphocyte telomere length. Results: Baseline telomere length was shorter than age-adjusted normative values (median difference: − 1.8 kilobases; 95% CI − 2.4, − 1.1); equivalent to 21 years (95% CI 17, 25) of accelerated chronological aging. Compared to control, exercise alone did not change 8-iso-PGF2α [9.9%; 95% confidence interval (CI) − 1.0, 20.8] or telomere length (13.8%; 95% CI − 15.6, 43.3). Compared to control, diet alone was associated with reduced 8-iso-PGF2α (− 10.5%; 95% CI − 19.5, − 1.5) but did not change telomere length (12.1%; 95% CI − 17.2, 41.3). Compared to control, exercise plus diet was associated with reduced 8-iso-PGF2α (− 9.8%; 95% CI − 18.7, − 0.9) but did not change telomere length (− 8.5%; 95% CI − 32.1, 15.2). Change in 8-iso-PGF2α did not correlate with change in telomere length (r = 0.07; 95% CI − 0.07, 0.20). Conclusion: In breast cancer survivors, diet alone or exercise plus diet were associated with reduced oxidative stress but did not change telomere length. This analysis may inform future trials that aim to optimize healthy aging in cancer survivors. [ABSTRACT FROM AUTHOR]

Agonists are ligands that bind to receptors and activate them. In the case of ligand-gated ion channels, such as the muscle-type nicotinic acetylcholine receptor, mechanisms of agonist activation have been studied for decades. Taking advantage of a reconstructed ancestral muscle-type β-subunit that forms spontaneously activating homopentamers, here we show that incorporation of human muscle-type α-subunits appears to repress spontaneous activity, and furthermore that the presence of agonist relieves this apparent α-subunit-dependent repression. Our results demonstrate that rather than provoking channel activation/opening, agonists may instead 'inhibit the inhibition' of intrinsic spontaneous activity. Thus, agonist activation may be the apparent manifestation of agonist-induced derepression. These results provide insight into intermediate states that precede channel opening and have implications for the interpretation of agonism in ligand-gated ion channels. Ligand-gated ion channels are activated/opened by agonists. Tessier et al. show that agonists can inhibit the inhibition of intrinsic basal activity, and thus that activation may instead be the manifestation of a derepression mechanism. [ABSTRACT FROM AUTHOR]

Background: The American Society of Breast Surgeons recommends genetic testing (GT) for all women with breast cancer (BC), but implementation and uptake of GT has not been well-described. Methods: A retrospective chart review was performed for newly diagnosed BC patients or patients with a newly identified recurrence of BC seen in a multidisciplinary clinic (MDBC) who were offered genetic counseling (GC) and GT. Results: The 138 women attending the MDBC had a median age of 54 years and comprised non-Hispanic whites (46%), Asians (28%), Hispanics (17%), blacks (4%), and other (5%). Of the 105 (76%) patients without prior GT, 100 (95%) accepted GC, with 93 (93%) of these 100 patients undergoing GT. The patients meeting the National Comprehensive Cancer Network (NCCN) guidelines for GT were more likely to undergo GT. Testing was performed with a 67- to 84-gene panel, together with an 8- to 9-gene STAT panel if needed. Among 120 patients with reports available, including 33 patients previously tested, 15 (12%) were positive (1 BLM, 1 BRCA1, 3 BRCA2, 1 BRIP1, 1 CFTR, 1 CHEK2, 1 MUTYH, 1 PALB2, 1 PRSS1, 1 RAD50, 1 RET, and 2 TP53), 44 (37%) were negative, and 61 (51%) had an uncertain variant. The median time to STAT results (n = 50) was 8 days. The STAT results were available before surgery for 47 (98%) of the 48 STAT patients undergoing surgery. Conclusions: New BC patients attending the MDBC demonstrated high rates of acceptance of GC and GT. The combination of GC and GT can offer timely information critical to patient risk assessment and treatment planning. [ABSTRACT FROM AUTHOR]

Astrocytes are critical components of the neurovascular unit that support blood-brain barrier (BBB) function. Pathological transformation of astrocytes to reactive states can be protective or harmful to BBB function. Here, using a human induced pluripotent stem cell (iPSC)-derived BBB co-culture model, we show that tumor necrosis factor (TNF) transitions astrocytes to an inflammatory reactive state that causes BBB dysfunction through activation of STAT3 and increased expression of SERPINA3, which encodes alpha 1-antichymotrypsin (α1ACT). To contextualize these findings, we correlated astrocytic STAT3 activation to vascular inflammation in postmortem human tissue. Further, in murine brain organotypic cultures, astrocyte-specific silencing of Serpina3n reduced vascular inflammation after TNF challenge. Last, treatment with recombinant Serpina3n in both ex vivo explant cultures and in vivo was sufficient to induce BBB dysfunction-related molecular changes. Overall, our results define the TNF-STAT3-α1ACT signaling axis as a driver of an inflammatory reactive astrocyte signature that contributes to BBB dysfunction. Inflammation of brain endothelial cells is seen in neurodegenerative conditions and in aging. Here the authors examine the role of astrocytes in blood brain barrier function using an iPSC-derived cell co-culture model. [ABSTRACT FROM AUTHOR]

Purpose: A longer menarche-to-first pregnancy window of susceptibility (WOS) is associated with increased breast cancer risk. Whether physical activity, an established preventive risk factor, during the menarche-to-first pregnancy WOS offsets breast cancer risk overall or for specific molecular subtypes is unclear.Methods: We examined the prospective association between physical activity during the menarche-to-first pregnancy WOS and breast cancer risk in the California Teachers Study (N = 78,940). Recreational physical activity at multiple timepoints were recalled at cohort entry, and converted to metabolic equivalent of task hours per week (MET-hrs/wk). We used multivariable Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).Results: We observed 5,157 invasive breast cancer cases over 21.6 years of follow-up. Longer menarche-to-first pregnancy WOS (≥ 20 vs. < 15 years) was associated with higher breast cancer risk (HR = 1.23, 95% CI = 1.13-1.34). Women with higher physical activity level during menarche-to-first pregnancy had lower risk of invasive breast cancer (≥ 40 vs. < 9 MET-hrs/wk: HR = 0.89, 95% CI = 0.83-0.97) and triple-negative subtype (≥ 40 vs. < 9 MET-hrs/wk: HR = 0.53, 95% CI = 0.32-0.87). No association was observed for luminal A-like and luminal B-like subtypes. Higher physical activity level was associated with lower breast cancer risk among women with moderate (15-19 years) menarche-to-first pregnancy intervals (≥ 40 vs. < 9 MET-hrs/wk: HR = 0.80, 95% CI = 0.69-0.92), but not with short (< 15 years) or long (≥ 20 years) intervals.Conclusion: Physical activity during a WOS was associated with lower breast cancer risk in our cohort. Understanding timing of physical activity throughout the life course in relationship with breast cancer risk maybe important for cancer prevention strategies. [ABSTRACT FROM AUTHOR]

Purpose: Obesity increases the risk of cancer recurrence and death in survivors of breast cancer. This study tested the hypothesis that exercise alone, diet alone, and the combination of exercise plus diet reduce body weight and improve body composition in survivors of breast cancer. Methods: In this 2 × 2 factorial trial, 351 survivors of breast cancer with overweight or obesity were randomized to one of four treatment groups for 52 weeks: control, exercise alone, diet alone, or exercise plus diet. Endpoints included body weight and body composition measured by dual-energy x-ray absorptiometry. Results: After 52 weeks, compared with control, diet alone [− 5.39 kg (95% CI − 7.24, − 3.55);− 6.0% (95% CI − 8.0, − 3.9)] and exercise plus diet [− 6.68 kg (95% CI − 8.46, − 4.90);− 7.4% (95% CI − 9.4, − 5.4)] reduced body weight; exercise alone did not change body weight. Compared with control, diet alone [− 3.59 kg (95% CI − 5.00, − 2.17)] and exercise plus diet [− 4.28 kg (95% CI − 5.71, − 2.84)] reduced fat mass; exercise alone did not change fat mass. Compared with control, diet alone [− 0.82 kg (95% CI − 1.50, − 0.15)] and exercise plus diet [− 1.24 kg (95% CI − 1.92, − 0.56)] reduced lean mass; exercise alone did not change lean mass. Compared with control, exercise alone, diet alone, and exercise plus diet did not change bone mineral density. Conclusion: In survivors of breast cancer with overweight or obesity, diet alone or diet plus exercise produced clinically meaningful weight loss at week 52. The majority of weight loss was fat mass. [ABSTRACT FROM AUTHOR]

The authors discuss the target article by J. Connor and colleagues which described a continuum of adaptation responses to female genital cutting (FGC). Topics include reason that the implications of FGC and resulting sexual pain are a highly complex, suggested key factor underlying a broader construct of psychologically flexibility, and key barrier in assessment and treatment of the effects of FGC.

Cumulative evidence supports the association between perceived childhood neglect and adulthood psychological and physical health. To date, pathways mediating this association remain largely unknown, though other evidence suggests that negative patterns of appraisal, including injustice perception related to pain, may be shaped by prior adverse social experiences. Consequently, the current study examined perceived injustice about chronic pain as a possible factor connecting childhood neglect and pain-related outcomes, given its relevance for both adaptation to chronic pain and to prior adverse life experiences. Patients (n = 742) visiting a tertiary pain clinic completed a survey administered via the Collaborative Health Outcomes Information Registry. Path modeling analyses were used to examine perceived injustice as a mediator of the relationships between childhood neglect and affective distress and physical function, after controlling for pain intensity and pain catastrophizing. Patients endorsing childhood neglect reported higher levels of perceived injustice and worse affective distress and physical function. Further, inclusion of perceived injustice as a mediator fully accounted for the relationship between neglect and current levels of physical function, and accounted for a significant proportion of the relationship between neglect and current levels of affective distress. These preliminary findings suggest that perceived injustice appears to be a more proximal factor by which prior experiences of neglect may adversely affect adaptation to chronic pain. Given the single-item assessment of childhood neglect and cross-sectional nature of the current findings, further research may focus on replicating these findings in longitudinal studies with validated measures and examining other adverse social experiences (e.g., abuse, social disparities) that may contribute to injustice perception and poor pain-related outcomes. [ABSTRACT FROM AUTHOR]

Hydride generation (HG) coupled to cryotrapping was employed to introduce, separately and with high selectivity, four gaseous arsanes into a direct analysis in real time source for high-resolution mass spectrometry (DART-HR-MS). The arsanes, i.e., arsane (AsH3), methylarsane (CH3AsH2), dimethylarsane ((CH3)2AsH), and trimethylarsane ((CH3)3As), were formed under HG conditions that were close to those typically used for analytical purposes. Arsenic containing ion species formed during ambient ionization in the DART were examined both in the positive and negative ion modes. It was clearly demonstrated that numerous arsenic ion species originated in the DART source that did not accurately reflect their origin. Pronounced oxidation, hydride abstraction, methyl group(s) loss, and formation of oligomer ions complicate the identification of the original species in both modes of detection, leading to potential misinterpretation. Suitability of the use of the DART source for identification of arsenic species in multiphase reaction systems comprising HG is discussed. [ABSTRACT FROM AUTHOR]

Purpose: Breast cancer survivorship is common (90% of women survive 5 or more years), but many women are not able to return to full function and well-being after treatment due to functional limitations, persistent pain, and inability to perform daily activities. Since each surgical reconstructive option (e.g., autologous tissue flaps versus implants) can impact shoulder and arm function differently, it is important to understand how shoulder and upper limb strength, mobility, and function are influenced by the type of surgical intervention. Efforts can then focus on prehabiliation strategies to prevent the onset of limitations and on developing rehabilitation protocols that directly target shortcomings. Methods: The current paper presents a review summarizing how shoulder and upper limb function may be affected by surgical mastectomy and breast reconstruction. Results: Mastectomy and breast reconstruction with implants or autologous tissues present different functional outcomes for patients. Each surgical procedure is associated with unique sequelae derived from the tissues and procedures associated with each surgery. Characterizing the specific functional outcomes associated with each surgical approach will promote the development of targeted rehabilitation strategies that can be implemented into a multidisciplinary treatment planning pathway for breast cancer patients. Conclusions: Surgical treatments for breast cancer, including mastectomy and breast reconstruction, can have negative effects. Focused efforts are needed to better understand treatment-specific effects so that targeted rehabilitation can be developed to improve patient function, QoL, and ability to return to work and life activities post-breast cancer. [ABSTRACT FROM AUTHOR]

Standard of care for large or complex renal stones is percutaneous nephrolithotomy. Robotic pyelolithotomy, however, may be a feasible alternative, but limited data exist on its outcomes and complications. Our study objective was to describe the outcomes and peri-operative complications of robotic pyelolithotomy for complex renal calculi. We performed a retrospective analysis of robotic pyelolithotomy at our tertiary academic institution from 2015 to 2018. Demographics, stone clearance rates, complications, estimated blood loss, operative time, and length of stay were reported. 15 patients were included with a median age of 59 years (SD 15.3, 27–80) and BMI 25 kg/m2 (SD 4.6, 20.9–35.7). Median follow-up was 4 months. Median stone size was 3 cm (SD 1.2 cm, 2–5 cm). Concomitant pyeloplasty was performed in 2 patients, complete stone clearance in 11 (73%) cases and 4 out of 5 (80%) with a solitary stone. Median operative time was 191.5 min (SD 64.8 min, 110–303 min), with no open conversion. Median EBL was 70 ml (SD 65 ml, 20–250 ml) and median length of stay was 1 day (SD 1 day, 1–5 days). Median change in creatinine and eGFR were − 0.02 mg/dl and + 3 ml/min/1.73 m2. There were no cases of sepsis or post-operative fever and only one case of transfusion. Robotic pyelolithotomy appears safe and effective. Ultimately, less bleeding, lower septicemia, renal parenchymal preservation, and favorable stone-free rates in a single procedure make this as an attractive option in the management of select patients with large renal stone disease. [ABSTRACT FROM AUTHOR]

As the overlap between heart disease and cancer patients increases as cancer-specific mortality is decreasing and the surviving population is aging, it is necessary to identify cancer patients who are at an increased risk of death from heart disease. The purpose of this study is to identify cancer patients at highest risk of fatal heart disease compared to the general population and other cancer patients at risk of death during the study time period. Here we report that 394,849 of the 7,529,481 cancer patients studied died of heart disease. The heart disease-specific mortality rate is 10.61/10,000-person years, and the standardized mortality ratio (SMR) of fatal heart disease is 2.24 (95% CI: 2.23–2.25). Compared to other cancer patients, patients who are older, male, African American, and unmarried are at a greatest risk of fatal heart disease. For almost all cancer survivors, the risk of fatal heart disease increases with time. As the overlap between heart disease and cancer patients increases as cancer-specific mortality is decreasing, identifying cancer patients who are at an increased risk of death from heart disease is important. Here the authors report on risk of death from heart diseases among more than 7.5 million cancer patients. [ABSTRACT FROM AUTHOR]

Introduction: The impact of hepatitis C virus (HCV) infection on outcomes following major orthopaedic interventions, such as joint arthroplasty or spine surgery, has not been effectively studied in the past. Most prior studies are impaired by small samples, limited surveillance for adverse events, or the potential for selection bias to confound results. In this context, we sought to evaluate the impact of HCV infection on 90-day outcomes following joint arthroplasty or spine surgery using propensity-matched techniques.Materials and Methods: This study utilized 2006-2014 claims from TRICARE insurance. Adults who received spine surgical procedures, total knee and hip arthroplasty were identified. Covariates included demographic factors, a diagnosis of HCV and medical co-morbidities defined by International Classification of Disease-9th revision (ICD-9) code. Outcomes consisted of 30- and 90-day mortality, complications and readmission. A propensity score was used to balance the cohorts with logistic regression techniques employed to determine the influence of HCV infection on post-operative outcomes.Results: The propensity-matched cohort consisted of 2262 patients (1131 with and without HCV). Following logistic regression, patients with HCV were found to have increased odds of 30-day complications (OR 1.87; 95% CI 1.33, 2.64; p < 0.001), 90-day complications (OR 1.55; 95% CI 1.16, 2.08; p = 0.003) and 30-day readmission (OR 1.46; 95% CI 1.04, 2.05; p = 0.03).Conclusion: HCV infection was found to increase the risk of complication and readmission following spine surgery and total joint arthroplasty. Patients should be counseled on their increased risk prior to surgery. Health systems that treat a higher percentage of patients with HCV need to consider the increased risk of complications and readmission when negotiating with insurance carriers. [ABSTRACT FROM AUTHOR]

Purpose: The goal of this RCT was to examine the efficacy and safety of a web-based program to improve cardiovascular and bone health outcomes, among 35 BRCA1/2+ breast cancer survivors who underwent prophylactic oophorectomy and thus experienced premature surgical menopause.Methods: A 12-month commercially available web-based lifestyle modification program (Precision Nutrition Coaching) was utilized. Cardiovascular fitness, dietary intake, leisure time activity, body composition, bone mineral density, bone structure, and muscle strength were assessed.Results: Average adherence to all program components was 74.8 %. Women in the intervention group maintained their cardiovascular fitness level over the 12 months (1.1 ± 7.9 %), while the control group significantly decreased fitness capacity (-4.0 ± 7.5 %). There was a significant difference between groups in percent change of whole body bone area (-0.8 ± 2.5 control and 0.5 ± 1.30 intervention). We also observed decreased BMI (-4.7 ± 6.2 %) and fat mass (-8.6 ± 12.7 %) in the intervention group due to significant concomitant decreases in caloric intake and increases in caloric expenditure. The control group demonstrated decreased caloric intake and decreased lean tissue mass.Conclusions: In this population at high risk for detrimental cardiovascular and bone outcomes, a commercially available lifestyle intervention program mitigated a decline in cardiovascular health, improved bone health, and decreased weight through fat loss.Implications For Cancer Survivors: Precision Nutrition Coaching has shown benefit in breast cancer survivors for reduced risk of deleterious cardiovascular and bone outcomes. [ABSTRACT FROM AUTHOR]

Background: The current studies investigated associations between pain intensity and pain frequency with loneliness, hostility, and social functioning using cross-sectional, longitudinal, and within-person data from community-dwelling adults with varying levels of pain. Method: Secondary analysis of preexisting data was conducted. Study 1 investigated cross-sectional (baseline data: n = 741) and longitudinal (follow-up data: n = 549, observed range between baseline and follow-up: 6–53 months) associations. Study 2 tested within-person associations using daily diaries across 30 days from a subset of the participants in Study 1 (n = 69). Results: Cross-sectionally, pain intensity and frequency were associated with higher loneliness (βintensity = 0.16, βfrequency = 0.17) and worse social functioning (βintensity = − 0.40, βfrequency = − 0.34). Intensity was also associated with higher hostility (β = 0.11). Longitudinally, pain intensity at baseline predicted hostility (β = 0.19) and social functioning (β = − 0.20) at follow-up, whereas pain frequency only predicted social functioning (β = − 0.21). Within people, participants reported higher hostility (γ = 0.002) and worse social functioning (γ = − 0.013) on days with higher pain, and a significant average pain by daily pain interaction was found for loneliness. Pain intensity did not predict social well-being variables on the following day. Conclusion: Pain intensity and frequency were associated with social well-being, although the effects were dependent on the social well-being outcome and the time course being examined. [ABSTRACT FROM AUTHOR]

In recent years, law enforcement agencies have enhanced intimate partner violence (IPV) policies and increased the frequency of required training. Yet, there is limited research that addresses how experience and training are related to evaluations of heterosexual and same-sex disputants in an IPV incident. This research investigates how officers perceive heterosexual and same-sex disputants in IPV incidents and examines how officer experience, frequency, and recency of required IPV training affect evaluations. Law enforcement officers (n = 309) across 27 states responded to a hypothetical scenario of an IPV incident between a heterosexual or same-sex couple. Dependent variables included perpetrator and victim arrest, perceived fairness of non-arrest options, willingness to provide referrals for perpetrator and victim, and severity of victim injury. Officers believed that the use of some non-arrest options was fairer when the perpetrator was a gay male or heterosexual female and there were no significant effects for arrest options. Referrals to a domestic violence hotline and injury severity varied by perpetrator and victim gender and sexual orientation. While officer experience played a role in non-arrest options, frequency and recency of officer training were not related to dependent variables of interest. Officers embrace evaluations of IPV that demonstrate differential evaluations of the incident as a result of gender and sexual orientation. These evaluations may have implications for the legitimacy of claims and safety and justice for victims and officers. [ABSTRACT FROM AUTHOR]

This document is a correction notice for an article titled "Living with wildlife: a review of advances in social-ecological analysis across landscapes" published in the journal Landscape Ecology. The correction addresses an incorrect citation in the original article, which has now been corrected. The correction notice also includes a statement from the publisher, Springer Nature, emphasizing their neutrality regarding jurisdictional claims and institutional affiliations. The authors of the original article are Vanessa Hull, Xiaoxing Bian, Diane J. Episcopio-Sturgeon, Christian J. Rivera, Viviana Rojas-Bonzi, and Anita T. Morzillo. [Extracted from the article]

Purpose: Two case-control studies reported a 50 % decreased breast cancer risk among women who experienced menopausal vasomotor symptoms (VMS), but one cohort study found no association. VMS may be triggered by declining estrogen levels during menopause, whereas elevated estrogen levels have been associated with increased breast cancer risk. VMS may thus be indicative of lower susceptibility to breast cancer.Methods: We evaluated this relationship in the longitudinal Study of Women's Health Across the Nation (SWAN), using discrete survival analysis of approximately annual data on VMS and self-reported breast cancer occurrences for up to 13 years of follow-up in 3,098 women who were pre- or early perimenopausal at enrollment.Results: Over an average 11.4 years of follow-up, 129 incident breast cancer cases were self-reported, and approximately 50 % of participants experienced VMS. Symptomatic women had a reduced risk of breast cancer compared to non-symptomatic women (adjusted HR 0.63, 95 % CI 0.39, 1.00). The association was stronger in the subgroup of women who fully transitioned to postmenopause during follow-up (n = 67 cases, adjusted HR 0.45, 95 % CI 0.26, 0.77).Conclusion: VMS appeared to be a marker of reduced breast cancer risk. Future research is needed to understand the biology underlying this relationship. [ABSTRACT FROM AUTHOR]

Background: Clinical activity and quality of life (QOL) indices assess disease activity in Crohn's disease (CD) and ulcerative colitis (UC). However, a paucity of data exists on the validity of these indices according to disease characteristics.Aims: To examine the correlation between QOL and clinical activity indices and endoscopic disease activity according to disease characteristics.Methods: We used a prospective registry to identify CD and UC patients ≥18 years old with available information on Short Inflammatory Bowel Disease Questionnaire scores (SIBDQ), Harvey-Bradshaw Index (HBI) and simple endoscopic scores for CD (SES-CD), and Simple Clinical Colitis Activity Index (SCCAI) and Mayo endoscopic score for UC. We used Spearman rank correlations to calculate correlations between indices and Fisher transformation to compare correlations across disease characteristics.Results: Among 282 CD patients, we observed poor correlation between clinical activity and QOL indices to SES-CD with no differences in correlation according to disease characteristics. Conversely, among 226 UC patients, clinical activity and QOL had good correlation to Mayo endoscopic score (r = 0.55 and -0.56, respectively) with better correlations observed with left-sided versus extensive colitis (r = 0.73 vs. 0.45, p = 0.005) and shorter duration of disease (r = 0.61 vs. 0.37, p = 0.04).Conclusions: Our data suggest good correlation between SCCAI and endoscopic disease activity in UC, particularly in left-sided disease. Poor correlations between HBI or SIBDQ and SES-CD appear to be consistent across different disease phenotypes. [ABSTRACT FROM AUTHOR]

The article discusses the need to implement a patient-centered approach to achieve the primary goals of chronic pain management. Topics include the lack of progress in chronic pain management, details of an online patient-reported outcome measurement tool called PainTracker developed by clinicians and pharmacists at the University of Washington, and the role of primary care physicians in the management of chronic pain.

Purpose: A key component to chronic pain management regimens is the use of analgesic medications. Psychological factors, such as mood states, may also affect the use of pain medications for individuals with chronic pain, but few observational studies have examined how these factors may predict pain medication use at the daily level.Methods: Daily assessments from 104 individuals with back pain were used to examine fluctuations in daily pain intensity, mood, sleep quality, and physical activity as predictors of the likelihood of pain medication (opioid and non-opioid) use and levels of medication use on the same day.Results: Pain intensity and mood ratings significantly predicted whether participants used pain medication on the same day, while only pain intensity predicted whether participants used more medication than usual. Further, current opioid users were more likely to increase the amount of their medication use on days of higher pain.Discussion: This article identifies fluctuations in daily pain intensity and mood as salient predictors of daily pain medication use in individuals with recurrent back pain. The current study is among the first to highlight both pain and mood states as predictors of daily pain medication use in individuals with back pain, though future studies may expand on these findings through the use of higher-resolution daily medication use variables. [ABSTRACT FROM AUTHOR]

Background: Some surgeons perform flexible fiberoptic laryngoscopy (FFL) in all patients prior to thyroid cancer operations. Given the low likelihood of recurrent laryngeal nerve (RLN) or aerodigestive invasion in clinically low-risk thyroid cancers, the value of routine FFL in this group is controversial. We hypothesized that routine preoperative FFL would not be cost effective in low-risk differentiated thyroid cancer (DTC).Methods: A decision model was constructed comparing preoperative FFL versus surgery without FFL in a clinical stage T2 N0 DTC patient without voice symptoms. Total thyroidectomy and definitive hemithyroidectomy were both modeled as possible initial surgical approaches. Outcome probabilities and their corresponding utilities were estimated via literature review, and costs were estimated using Medicare reimbursement data. Sensitivity analysis was conducted to examine the uncertainty of cost, probability, and utility estimates in the model.Results: When the initial surgical strategy was total thyroidectomy, routine preoperative FFL produced an incremental cost of $183 and an incremental effectiveness of 0.000126 quality-adjusted life-years (QALYs). The incremental cost-effectiveness ratio (ICER) for routine FFL prior to total thyroidectomy was $1.45 million/QALY, exceeding the $100,000/QALY threshold for cost effectiveness. Routine FFL became cost effective if the preoperative probability of asymptomatic vocal cord paralysis increased from 1.0% to 4.9%, or if the cost of preoperative FFL decreased from $128 to $27. Changing the extent of initial surgery to hemithyroidectomy produced a higher ICER for routine FFL of $1.7 million/QALY.Conclusion: Routine preoperative FFL is not cost effective in asymptomatic patients with sonographically low-risk DTC, regardless of the initial planned extent of surgery. [ABSTRACT FROM AUTHOR]

Exercise is recommended following cancer diagnosis and may be particularly valuable for women receiving cardiotoxic chemotherapy treatments. We investigated breast cancer patient preference on exercise programming in a prospective manner and retrospectively assessed length of time between diagnosis and chemotherapy initiation. Sixty-seven newly diagnosed breast cancer patients responded to questions regarding exercise programming related to cancer treatment and surveys on current activity level. Additionally, a retrospective chart review was conducted on 500 random breast cancer patients. Age, cancer stage, treatment, and treatment dates were extracted. Women were interested in, or, absolutely wanted to, participate in an exercise program before treatment (76.2%). There was uncertainty regarding willingness to delay treatment; 49.2% were willing to delay their treatment if the program was recommended by their doctors, 41.8% would not, and 9.0% were too unsure to respond. However, women would like to hear information about an exercise program for cancer patients when they are first diagnosed (61.9%). We observed that 64.6% of women were below recommended levels of physical activity; yet, current activity was not associated with an interest in an exercise program or willingness to delay treatment. Retrospectively, we observed an average interval of 72.6 ± 34.6 days between cancer diagnosis and initiation of anthracycline-based chemotherapy treatment, with younger women with more advanced cancer receiving anthracycline-based chemotherapy. Based on patient preference and length of time to chemotherapy initiation, a reasonable next step to promote the current recommendations for exercise could be to integrate exercise into breast cancer care earlier in treatment. [ABSTRACT FROM AUTHOR]

Purpose: Hypogonadism has been linked with systemic inflammation and opioid use in males with advanced cancer. We aimed to investigate the interaction of gonadal status with systemic inflammation and opioids in determining nutritional status and prognosis in advanced pancreatic cancer.Methods: One hundred and seventy-five patients (92 males, 83 postmenopausal females) with unresectable pancreatic cancer were studied. Serum sex steroids (total testosterone [TT], calculated free testosterone [cFT], oestradiol, sex hormone binding globulin), gonadotropins (follicle-stimulating hormone and luteinising hormone) and pro-inflammatory mediators (C-reactive protein [CRP], interleukin-6 [IL-6], soluble tumour necrosis factor receptor 75 [sTNFR75]) were measured, and nutritional assessment and opioid use recorded.Results: Seventy-three percent of males were hypogonadal (by cFT definition). cFT correlated positively with BMI (r (2) =0.349; p< 0.001) and grip strength (r (2) = 0.229; p = 0.034) and inversely with weight loss (r (2) = -0.287; p = 0.007), CRP (r (2) = -0.426; p < 0.001) and IL-6 (r (2) = -0.303; p = 0.004). CRP (p= 0.007), opioid dosage (p = 0.009) and BMI (p = 0.005) were independent determinants of cFT on ANOVA. Hypogonadal males demonstrated worsened survival compared with eugonadal patients (TT: OR of death = 2.87; p < 0.001; cFT: OR = 2.26; p = 0.011). Furthermore, male opioid use was associated with decreased TT (p < 0.001) and cFT (p < 0.001) and worsened survival (OR = 1.96; p = 0.012). In contrast, 18% of postmenopausal females exhibited premenopausal ("hyperoestrogenic") oestradiol levels. Oestradiol correlated positively with sTNFR75 (r (2) = 0.299; p = 0.008). CRP (p < 0.001) was an independent determinant of oestradiol. Hyperoestrogenic females demonstrated worsened survival compared with eugonadal patients (OR = 2.43; p = 0.013).Conclusions: In males with pancreatic cancer, systemic inflammation and opioid use are associated with hypogonadism. Male hypogonadism and female hyperoestrogenism are associated with shortened survival in advanced pancreatic cancer. [ABSTRACT FROM AUTHOR]

G(2) checkpoint inhibitors can force cells arrested in G(2) phase by DNA damage to enter mitosis. In this manner, several G(2) checkpoint inhibitors can enhance killing of cancer cells by ionizing radiation and DNA-damaging chemotherapeutic agents, particularly in cells lacking p53 function. All G(2) checkpoint inhibitors identified to date target protein phosphorylation by inhibiting checkpoint kinases or phosphatases. Using a phenotypic cell-based assay for G(2) checkpoint inhibitors, we have screened a large collection of plant extracts and identified Z-Cryptofolione and Cryptomoscatone D2 as highly efficacious inhibitors of the G(2) checkpoint. These compounds and related pyrones also inhibit nuclear export. Leptomycin B, a potent inhibitor of Crm1-mediated nuclear export, is also a very potent G(2) checkpoint inhibitor. These compounds possess a reactive Michael acceptor site and do not appear promising as a radiosensitizing agents because they are toxic to unirradiated cells at checkpoint inhibitory concentrations. Nevertheless, the results show that inhibition of nuclear export is an alternative to checkpoint kinase inhibition for abrogating the G(2) checkpoint and they should stimulate the search for less toxic nuclear export inhibitors. [ABSTRACT FROM AUTHOR]

In addition to recurrent pain, fatigue, and increased rates of physical disability, individuals with rheumatoid arthritis (RA) have an increased prevalence of some mental health disorders, particularly those involving affective or mood disturbances. This narrative Review provides an overview of mental health comorbidities in RA, and discusses how these comorbidities interact with disease processes, including dysregulation of inflammatory responses, prolonged difficulties with pain and fatigue, and the development of cognitive and behavioural responses that could exacerbate the physical and psychological difficulties associated with RA. This article describes how the social context of individuals with RA affects both their coping strategies and their psychological responses to the disease, and can also impair responses to treatment through disruption of patient-physician relationships and treatment adherence. Evidence from the literature on chronic pain suggests that the resulting alterations in neural pathways of reward processing could yield new insights into the connections between disease processes in RA and psychological distress. Finally, the role of psychological interventions in the effective and comprehensive treatment of RA is discussed. [ABSTRACT FROM AUTHOR]

To compare impact of incident diabetes on atherosclerotic cardiovascular disease (ASCVD) risk among postmenopausal women according to statin use. Prospective data from 120,499 postmenopausal women without prevalent diabetes or cardiovascular disease at baseline from the Women's Health Initiative were used. Incident diabetes was self-reported annually and defined as treatment with pills or injectable medication for diabetes. Current statin use was determined at enrollment and years 1, 3, 6, 9 and 13.5 in the three clinical trial arms, and at baseline, year 3, and 13.5 for the observational study. The primary outcome was incident ASCVD events, self-reported annually and adjudicated by blinded local and central physicians. Incident diabetes and statin use status were fitted as time-varying covariates in Cox regression models to assess ASCVD risk during an average follow-up of 13.6 years. For those not on statins at the time of diabetes diagnosis, there was a 42 % increased risk of ASCVD [hazard ratio (HR) 1.42, 95 % CI 1.28-1.58] among women with incident diabetes versus those without diabetes. Among women on statins, there was a 39 % increased risk of ASCVD (HR 1.39, 95 % CI 1.12-1.74) in women with incident diabetes versus those without diabetes. The increased ASCVD risk due to diabetes was similar between women before or after initiating statins ( P = 0.89). Whether diabetes was diagnosed before or after statin use did not alter the increased risk of ASCVD associated with diabetes. Mitigating the increased incidence of diabetes in statin users could increase the ASCVD benefit-to-risk ratio of statins. [ABSTRACT FROM AUTHOR]

The article focuses on a study related to assessment of sensory stimuli sensitivity though development of Sensory Hypersensitivity Scale (SHS). Topics discussed include higher sensitivity of women to SHS as compared to men observation of same total SHS score in healthy and patients suffering from chronic back pain, correlation between SHS and Highly Sensitive Person (HSP) scores and relevance of central sensitization and back pain relationship in women.