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Introduction: Recent fMRI studies have revealed altered activations in key regions for threat and affective processing of pain in motor imagination tasks. Yet, research in this vein is still lacking in people with chronic whiplash (CWAD). Methods: Sixty CWAD and 32 pain-free participants were included. In the scanner, participants were presented with pictures divided into 3 categories (5 weight bearing, 5 non-weight bearing and 5 neutral pictures) taken from the Pictorial Fear of Activity Scale-Cervical***questionnaire (jittered event-related design). After the scanning, participants were asked to rate each picture in terms of worry, desire to avoidance, anxiety, expected pain. SPM software was used for pre-processing and analysis of the fMRI data. Results: Whole brain analysis revealed greater activation in CWAD for the contrast weight bearing versus neutral pictures in planum temporale/parietal operculum, post/pre-central gyrus, frontal pole, precuneus and posterior cingulate. CWAD have greater activation in precuneus and cerebellum in the non-weight bearing versus neutral contrast. CWAD scored pictures higher than controls, but no correlation between scores and the identified clusters was found. Discussion: The results from this study allow for a better understanding of the maladaptive pain cognitions associated with CWAD by investigating the underlying neural activity alterations. Process evaluation: Several challenges were encountered along the way (data collection and analyses) as this was my first fMRI study. [ABSTRACT FROM AUTHOR]

Introduction: Mediation analysis (MA) is becoming popular in pain research since allows for treatment effect decomposition by assessing indirect and direct effects. However, limitations specific to MA prevent from an unbiased causal inference of the current evidence. Methods: A MA was conducted in an RCT where Pain Neuroscience Approach (PNA) was compared to usual care in people with chronic spinal pain. Four mediators (pain catastrophizing, fear of movement, central sensitization and pain intensity) measured at post-intervention and three outcomes (disability, medication intake and health-related quality of life) measured at follow-up were included into the analysis. Confounding, interaction terms and causal (sequential) structure were accounted for in the model. Results: Reductions in fear of movement and central sensitization mediated improvements in disability and medication intake after PNA under various sequential decompositions (proportion mediated range: 29% to 58%). Discussion: Reductions in fear of movement as well as central desensitization seem to contribute to the effects of PNA when compared to usual care. Further research in this vein is needed for a strong interpretation about the causal structure of this process. Process evaluation: These results are part of a 2-year project divided in: (1) meta-analysis of current MAs in pain rehabilitation literature, (2) MA application in PNA. Thus, results from (2) will be framed within the context of the limitations highlighted in (1). [ABSTRACT FROM AUTHOR]

A model was developed to assess the lifetime costs and outcomes associated with haemophilia in Mexico. A retrospective chart review of 182 type A haemophiliacs was conducted for patients aged 0–34 years receiving one of three treatments: (i) cryoprecipitate at clinic; (ii) concentrate at home; or (iii) concentrate at clinic. Patients treated at home experienced 30% less joint damage, used 13–54% less factor VIII, had four times fewer clinic visits, and utilized half as many hospital days than those treated at a clinic. For cryoprecipitate at clinic patients, the annual incidence rates of HCV and HIV were calculated to be 3.6% and 1.4% respectively. The life expectancy for patients receiving cryoprecipitate and those receiving concentrate was estimated to be 49 years and 69 years respectively, with 58% of cryoprecipitate patients predicted to die of AIDS before age 69. Across the lifespan, the average annual cost of care was US$11 677 (MN$110 464) for cryoprecipitate at clinic patients, US$10 104 (M$95 580) for concentrate at home patients and US$18 819 (MN$178 027) for concentrate at clinic patients. Using a 5% discount rate, the incremental lifetime cost per year of life added for treatment with concentrate at home compared with cryoprecipitate at a clinic was US$738 (MN$6981). Rank order stability analysis demonstrated that the model was most sensitive to the cost of fVIII. These results indicate that treatment with concentrate at home compared with cryoprecipitate at a clinic substantially improves clinical outcomes at reduced annual cost levels. [ABSTRACT FROM AUTHOR]

A study of 150 extracted maxillary first premolars from citizens of Seville, Andalusia, southern Spain, revealed 60 teeth with one root (40.0%), 85 teeth with two roots (56.7%) and five teeth with three roots (3.3%). The distribution of root canal shapes in the sample showed that all teeth with two or three roots had type I root canals (each canal had one apical foramen). Conversely, most of the single-rooted maxillary first premolars had root canal shape type II two canals converging in the same apical foramen. Only 1.3% of the teeth had a unique orifice in the pulp chamber and only one root canal. These results emphasized the importance of good knowledge of the root canal morphology and the need for a careful radiographic examination as part of competent root canal therapy of maxillary first premolars. [ABSTRACT FROM AUTHOR]

An abstract of the article "Performance of cervical length and cervical consistency index to predict spontaneous preterm birth in low-risk population," by N. Baños and colleagues is presented.